A 76-YEAR-OLD white man discovered a lesion on his forehead in September 2001. He complained of symptoms related mainly to local bleeding and rapid growth of the lesion. Clinical examination revealed a bruiselike macule, measuring 15 × 10 cm, with an irregular, ulcerated, bleeding plaque. The lesion involved the entire forehead, and there were several purple-red satellite nodules covered by a gray-black crust. There was no lymphadenopathy in the neck, and a metastatic workup revealed no abnormalities.