An 83-year-old man presented with a 1-year history of a dusky erythematous patch and plaque over the left shoulder and scapula (Figure 1). It had been noted 1 year earlier by nursing staff. He had no history of trauma to the area. The patient reported occasional tenderness at the site after a hot shower or on a warm day. He had no relevant medical or dermatologic history. The lesion measured 15 × 22 cm. No violaceous papules were present at the superior aspect, and the inferior pole was indurated. The involved skin was warmer on palpation than the skin overlying the contralateral shoulder and scapula. Skin biopsy specimens were taken (Figure 2 and Figure 3).