Daniel Stulberg, MD

This 28-year-old woman presented with a large hyperpigmented patch on the right side of her upper back. Although the lesion developed over the past 2 years, it has been "sinking in" over the past 2 weeks. The patient denies any trauma, pain, discomfort, or pruritis, as well as any family history of cancers, lymphoma, or autoimmune disease. However, she has a history of gastroesophageal reflux disease and onychomycosis, and her grandfather has a similar lesion.

A 58-year-old woman presented to clinic with concerns about this skin lesion on her upper chest. She reports it has been present for 1 year and is slowly enlarging. The lesion is otherwise asymptomatic and her past history is only significant for rheumatoid arthritis (RA), for which she takes methotrexate and etanercept.

This 6-year-old boy presents to the ER with a 2-day history of increasing pain and swelling in his right ankle. On the day of his arrival, he also developed the rash pictured here. The patient denies any other symptoms aside from his ankle and knee pain. His chest X-ray, vital signs, complete blood count (CBC), and basic chemistry panel were normal, though urinalysis showed a trace of blood.