A 21-year-old Hispanic man presented with a 6-month history of papules on his face and arms. He was a mechanic and had moved to the United States from Mexico 3 years earlier. The lesions on his face were somewhat tender. He also complained of numbness of the inner aspect of his arms and weakness of his hands. He was otherwise healthy.
Several scattered, 2- to 5-mm, firm, shiny, red-brown papules were seen on the patient's face (Figure 1) and upper chest area and on the extensor aspect of his arms. The neurologic examination showed that he was insensitive to pinprick and light touch on the volar part of both arms but that he had no enlarged nerves or muscle weakness. He had a burn scar on the upper part of his right arm. A cutaneous biopsy specimen was obtained and stained with hematoxylin-eosin (Figure 2) and Fite stain (Figure 3).