Slow-growing, pink, indurated plaque on the arm

A 73-year-old man with a history of erythrodermic psoriasis treated with cyclosporine and adalimumab presented for evaluation of a slowly growing lesion on the left arm. The physical examination revealed a solitary 18-cm × 7-cm pink indurated plaque on the left antecubital fossa with scattered ulcerations (Fig 1). Punch biopsy specimens were obtained and sent for routine pathology and tissue culture. Periodic acid-Schiff stain was performed (Fig 2). A complete blood cell count and comprehensive metabolic panel were within normal limits, and an HIV assay was negative.

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