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Download the article PDF: Clinical Image Challenges May 2026
A 67-year-old man visits urgent care for a lesion on his right ankle that was first noticed 25 years ago. He reports that it has progressively grown larger over the past 6 months. The lesion is painless but is intermittently mildly pruritic. The patient denies any recent injury or past medical history besides chronic venous insufficiency. On dermatologic examination, a discrete dark brown plaque is noted posterior to the lateral malleolus with numerous surrounding spider veins, and deeper varicose veins are seen. A biopsy is taken, showing a proliferation of small, dilated vessels, fibrosis, and dermal edema.
View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
