A man in his 60s with diabetes underwent biopsy for an asymptomatic shiny indurated plaque on the right plantar foot, which had been slowly growing for the past year. The patient was then referred to a dermatology specialist for further treatment. The patient reported no fevers, chills, weight loss, or night sweats. He had long-standing, intermittent dyspnea on exertion, but no baseline shortness of breath, orthopnea, or bilateral lower extremity edema. The patient had occasional numbness in both legs in stocking distribution, attributed to diabetic neuropathy. Physical examination revealed a 4.5 cm waxy, nontender, smooth-surfaced, cobblestoned plaque located in the sulcus between the second and fourth toes (Figure, A). A biopsy specimen obtained by the patient’s podiatrist was sent to the dermatopathology laboratory for review.