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October 2009

Slowly Enlarging Nodule on a Finger—Quiz Case

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Arch Dermatol. 2009;145(10):1183-1188. doi:10.1001/archdermatol.2009.216-a

A 55-year-old man presented with a 4-month history of a slowly enlarging nodule on his right index finger. The nonhealing central portion of the nodule sporadically expressed minimal serosanguineous discharge. The patient reported intermittent pain but denied any trauma to the area. Overall, the patient was feeling well without any malaise, fatigue, or weight loss. Physical examination revealed a 1.5-cm boggy, nontender dermal nodule with a central 4-mm red, moist ulceration on the ulnar aspect of the right index finger distal phalanx (Figure 1). The patient demonstrated both active and passive range of motion without any pain or limitations. Examination of bilateral axillae revealed nontender, mobile, enlarged lymph nodes. A roentgenogram of the right hand revealed no bony involvement. A punch biopsy of the nodule was obtained for histological evaluation (Figure 2 and Figure 3) (hematoxylin-eosin, original magnification ×40 and ×400, respectively). The patient subsequently underwent further evaluation and definitive treatment.

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