Acta Demato-Venereologica 98-3CompleteContent | Page 25

QUIZ SECTION A Rapidly Expanding Ulcer in the Armpit of a 48-year-old Man: A Quiz Yael RENERT-YUVAL 1 , Sharon MERIMS 2 , Alexander MALY 3 and Yuval RAMOT 1 1 Department of Dermatology, 2 Center for Melanoma and Cancer Immunotherapy, Sharett Institute of Oncology, and 3 Department of Pathology, Hadassah – Hebrew University Medical Center, 9112001 Jerusalem, Israel. E-mail: [email protected] A 48-year-old healthy man presented to our dermatology outpatient referral clinic with a growing ulcer in his left armpit. The patient reported that the ulcer had developed following forceful hair plucking from this area. The lesion had appeared as a small papule one year earlier, with rapid growth and ulceration over the past 2 months. Clinical examination revealed an indurated, oval ulcer in the left armpit fold, measuring 5 cm in diameter, with a fibrotic ulcer bed and a hypergranulated, erythematous centre (Fig. 1A). The borders of the ulcer were undermined and darker than the surrounding skin tone, with colour ranging from pink to dark-purple/black. The skin around the ulcer showed erythematous plaques with no pustules or sinuses. Dermatoscopy revealed ulceration, with linear irregular vessels and milky-red blotches. No pigmented features were seen in the centre of the lesion (Fig. 1B). Previous treatment included oral and local antibiotics with no clinical response. What is your diagnosis? See next page for answer. Fig. 1. Clinical features. (A) Undermined, indurated ulcer in the patient’s left armpit with erythematous plaques in the surrounding skin. (B) Dermatoscopy showing an ulcerative lesion with milky-white blotches and linear irregular vessels. 384 doi: 10.2340/00015555-2858 Acta Derm Venereol 2018; 98: 384–385 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica.