A 42-year-old black man presented to the outpatient clinic with an expanding intensely pruritic plaque over his chest wall on the right side. He did not know exactly how long the plaque had been present. His medical, surgical, family, and social histories were noncontributory. He took no medications. Physical examination revealed an indurated, extensive plaque involving the right breast and the right side of the chest wall. The plaque was hard to palpation and had clearly delineated borders (Figure 1 and Figure 2). Axillary lymph nodes on the right side were palpable and fixed. Two biopsy specimens were obtained from different areas of involvement (Figure 3 and Figure 4). Computed tomography of the chest revealed an infiltrating tumor in the breast, with gynecomastia but no pulmonary invasion. Computed tomography of the abdomen and pelvis revealed no abnormalities. The patient's chemistry profile and liver function test results were normal, and his hemoglobin level was 12 g/dL (reference range, 13-17 g/dL), with a hematocrit of 38 g/dL (reference range, 40-51 g/dL). His prothrombin time, partial thromboplastin time, and international normalized ratio were also normal, as were the results of urinalysis.
Herbert CR, Russo GG, Boh EE. Large Plaque on the Chest Extending to the Back—Quiz Case. Arch Dermatol. 2003;139(11):1497-1502. doi:10.1001/archderm.139.11.1497-a