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JAMA Dermatology Clinicopathological Challenge
October 2014

Rapidly Enlarging Nodular Plaque on the Leg

Author Affiliations
  • 1Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
  • 2Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
JAMA Dermatol. 2014;150(10):1107-1108. doi:10.1001/jamadermatol.2014.1045

A white man in his 60s was referred to our dermatology clinic for rapidly enlarging lesions on his calf, thigh, and cheek. Three months prior, he had noticed a small nodule on his calf, with no overlying skin changes or tenderness. This progressed to a tender, nodular plaque while other lesions appeared. The patient denied other signs or symptoms. His medical history included Parkinson disease, for which he took no medication. Laboratory findings showed an elevated lactate dehydrogenase (LDH) level at 439 U/L (reference range, 118-242 U/L) (to convert LDH to microkatals per liter, multiply by 0.0167). Results from serum chemical analyses, complete blood cell count, and tests of liver functions were normal. Physical examination revealed a healthy-appearing man with a 4.0 × 4.0-cm pink, firm, tender nodular plaque on his left calf (Figure, A), a 5.0-cm firm, subcutaneous mass on his right thigh, and a 0.5 × 0.5-cm subcutaneous nodule on his left cheek. There was no cervical, axillary, or inguinal lymphadenopathy. A punch biopsy specimen was obtained from each lesion (Figure, B and C).

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