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May 2009

Giant Fleshy Mass Over the Left Axilla—Quiz Case

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Arch Dermatol. 2009;145(5):589-594. doi:10.1001/archdermatol.2009.89-a

A 34-year-old man presented with a 6-month history of an asymptomatic rapidly enlarging mass on the left axillary area that was occasionally bleeding (Figure 1). The patient was otherwise healthy, and findings from a review of systems were negative. In particular, he had no constitutional symptoms and no neurological complaints. Physical examination revealed a 15-cm, foul-smelling and bleeding multinodular beefy red tumor in the left axillary area with eroded surface and overlying hemorrhagic crust. In addition, there were enlarged left axillary lymph nodes and a 3-cm ulcerated plaque with indurated borders involving the web space between the left second and third fingers (Figure 2). On investigation, he reported first noticing the latter lesion 6 years ago. A skin biopsy at the time revealed granuloma annulare. Since then, the patient never sought medical attention because the lesion was slowly progressive and asymptomatic. Two biopsy specimens obtained from both lesions revealed similar histologic features (Figure 3 and Figure 4).

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