A 70-year-old Chinese male with a medical history of hypertension, hyperlipidemia, and ischemic heart disease was referred to the urology clinic for 1 week of dysuria. He was previously given a course of antibiotics by a primary care physician for the presumptive treatment of urinary tract infection. On examination, there was a nonpruritic, erythematous, velvety plaque with superficial white scaling over the left base of his penis extending to the proximal aspect of the penile shaft (Figure 1). There was a palpable right inguinal lymph node. He was otherwise asymptomatic and claimed that his primary care physician had been treating it as chronic eczema for a few years. He denied exposure to sex workers or application of any creams to the affected area.