The patient is a 70-year-old male who presents to urgent care with numbness, pain, and difficulty opening his hands. His son, who drove his father to the appointment, notes that the skin also looks “bunched up in places.” The physician also observes what look like raised scars. The thumb and index finger seem unaffected.
Upon questioning, the patient says he started noticing smooth nodules “a couple years ago.” He attributed that to his many years as a carpenter. He also reports a decades-long tobacco habit and that he is an alcoholic who has been in recovery for 3 years.
View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.