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JAMA Clinical Challenge
September 25, 2013

Necrotic Black Eschars on the Lower Extremities in a 57-Year-Old Woman With Ovarian Cancer

Author Affiliations
  • 1Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Department of Dermatology, Brown University, Providence, Rhode Island
JAMA. 2013;310(12):1281-1282. doi:10.1001/jama.2013.277797

A 57-year-old woman with stage IIIC ovarian cancer presents with painful leg ulcerations of 3 months’ duration. She denies fevers, chills, and other systemic symptoms. Her cancer was diagnosed 6 months ago, and she was treated with primary surgical debulking, with partial omentectomy, loop ileostomy, and 4 cycles of chemotherapy with paclitaxel + carboplatin and panitumumab + gemcitabine. She denies use of alcohol or illicit substances. Physical examination reveals necrotic black eschars and scattered stellate purpuric patches on the lower extremities (Figure, A and B). All areas are exquisitely tender to palpation. The remainder of the examination is unremarkable.