A 65-year-old man was referred with an ulcerating nodule on his foreskin. The nodule had started 3 months earlier as a small papule and had grown steadily. It was pruritic, and there had been some contact bleeding on washing. Micturition was unimpeded. His medical history included benign prostatic hypertrophy, hypertension, and type 2 diabetes mellitus, complicated by nephropathy, neuropathy, and retinopathy. His medications included amlodipine, glyburide, bendroflumethiazide, and finasteride. He had had an episode of epididymo-orchitis 2 years previously, but there was no history ofsexually transmitted disease.