Jesse Lee Fitzgerald

An 84-year-old man presented to the clinic for evaluation of a pruritic rash on the back of 6 months’ duration that spread to the neck and chest over the past 2 months and then to the abdomen and thighs more recently. His primary care provider prescribed a 1-week course of oral steroids and steroid cream. The oral medication did not help, but the cream alleviated the pruritus. He had a medical history of coronary artery disease, hypertension, and diabetes mellitus.

A 31-year-old woman presented with a slow-growing, tender, pruritic lesion on the right cheek of 4 to 5 months’ duration. She had been applying petroleum jelly and hydrocortisone cream 2.5% without any improvement. Physical examination revealed a 1×5-mm, pearly pink, erythematous, crusted papule with arborizing vessels surrounded by scattered pink papules with white dots within. No cervical lymphadenopathy was appreciated on physical examination, and the patient denied any other systemic symptoms.

A 47-year-old woman with a history of combined variable immunodeficiency presented with a 2.6×2.4-cm nodule on the lateral aspect of the right calf that was first noticed 2 years prior as a smaller nodule. It increased in size and became painful to touch over the last 3 to 4 months. Following diagnostic biopsy, the nodule was removed by wide local excision and was tan-brown on gross dissection. The lesion showed dotlike perinuclear positivity with cytokeratin 20 immunostaining.