A 73-year-old-white man presented with a 5-year history of progressively increasing numbers of persistent and enlarging lesions on his ears, trunk, and extremities. He reported occasional bleeding of the ear lesions but was otherwise asymptomatic. His medical history was notable for long-standing thrombocytopenia and mild anemia.
Physical examination of the ears revealed several soft, cauliflowerlike, plum-colored papulonodules involving nearly all of the helixes and earlobes (Figure 1). Also, there were numerous 3- to 10-mm, soft, skin-colored to violaceous pink papules scattered on the back, lateral aspect of the upper arms, and anterior aspect of the thighs. Punch biopsy specimens were obtained from the left earlobe, shoulder, and upper arm (Figure 2 [hematoxylin-eosin, original magnification ×4] and Figure 3 [hematoxylin-eosin, original magnification ×40]).