A 51-year-old Honduran man presented with verrucous plaques on the right arm. He reported that years before the initial lesion appeared, he had received an abrasion from a burlap sack while spreading fertilizer. After an initial surgical excision 9 years earlier, the lesion recurred and slowly progressed to the state at presentation.
Physical examination revealed thick verrucous plaques on an erythematous base and associated edema affecting the right distal upper extremity (Figure 1). A skin biopsy specimen was obtained and stained with hematoxylin-eosin (Figure 2) and periodic acid–Schiff (Figure 3).