A 43-Year-Old Woman with a New Ulcer on One Hand

A 43-year-old woman presents with 2 weeks of a smooth nodule on her right hand. The patient denies recent travel but recalls that she “banged up” her hand while cleaning out a fresh-water fish tank prior to noticing the nodule. Past medical history is significant for renal transplantation.

Exam reveals a tender, erythematous plaque with an ulcer on dorsal aspect of her hand.              

View the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.