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JAMA Dermatology Clinicopathological Challenge
July 3, 2019

Linear and Arborizing Atrophic Plaque in an Elderly Man

Author Affiliations
  • 1Dermatology Clinic, Golden Valley Memorial Hospital, Clinton, Missouri
  • 2Ameripath Indiana, Indianapolis, Indiana
JAMA Dermatol. Published online July 3, 2019. doi:10.1001/jamadermatol.2019.1643

A man in his 80s presented with an 18-month history of an irregularly linear, rusty-brown, atrophic, streaklike plaque extending from the tip of his right shoulder to the right biceps, where it ended in arborizing purple plaque with scattered, slightly indurated, irregular papules within it (Figure, A and B). There was no warmth, thrills, or pulsations across the affected area. The patient complained about a mild tingling sensation within the lesion. The patient could not think of any triggers or causes for his condition and denied any aggravating or alleviating factors as well as any treatment attempts. Complete review of systems yielded negative results except for easy bruising. He was taking finasteride, montelukast, enalapril, and metoprolol. His medical history was significant for right total reverse shoulder replacement 5 years prior. Apart from the previously described lesion, his physical examination was unremarkable, and he had full range of motion of his right shoulder. A punch biopsy of the slightly indurated papule from the involved area on the right biceps was completed (Figure, C and D).