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JAMA Dermatology Clinicopathological Challenge
September 2013

Erythematous Papules, Plaques, and Nodular Lesions on the Trunk and Within Preexisting Scars

Author Affiliations
  • 1University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
  • 2Center of Excellence in Dermatology, Mannheim
JAMA Dermatol. 2013;149(9):1103-1104. doi:10.1001/jamadermatol.2013.186

A 79-year-old woman presented with yellowish erythematous papules, plaques, and nodules on her trunk and arms that had developed over the previous 5 months and were slowly growing (Figure, A). Some of the lesions were found within preexisting postsurgical scars, such as on the shoulder and submammary region (Figure, B). The lesions were asymptomatic but a cause for cosmetic concerns. The patient had a history of breast cancer 2 years previously with subsequent breast ablation and radiation therapy. Furthermore, she underwent an implantation of a shoulder endoprosthesis. She was referred to us by her gynecologist owing to suspected cutaneous metastatic carcinoma of the breast. Laboratory investigations revealed normal findings on complete blood cell count (white blood cell count of 3670/µL [reference range, 4200-10 000/µL]), a hemoglobin level of 11.1 g/dL (range, 12.3-15.2 g/dL), and a monoclonal gammopathy of IgG κ type. (To convert white blood cell count to × 109/L, multiply by 0.001; to convert hemoglobin level to grams per liter, multiply by 10.0.) A skin biopsy specimen was taken from the plaque within the scar in the submammary region (Figure, C).

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