REPORT OF A CASE
A 32-year-old woman was referred because of asymptomatic skin lesions of one year's duration. The first lesions appeared on the dorsa of her hands; subsequent lesions have occurred on her arms, trunk, and upper legs. They began as small, discrete, erythematous papules that enlarged over several months to approximately 5 mm, with white centers, slight crust, and rim telangiectasias (Figs 1 and 2). Once in this configuration, they did not change. There were approximately 30 lesions. The woman was in good health and had no other clinical or laboratory abnormalities. The lesions did not change with topical or intramuscular steroid therapy. A biopsy specimen obtained six months after the illness began is shown in Fig 3; a second biopsy specimen obtained after one year is shown in Fig 4.What is your diagnosis?