Hyperkeratotic plaques in a returning soldier

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A 36-year-old man had three well-circumscribed, ulcerated, hyperkeratotic plaques on his left arm. He reported noticing a small papule approximately two months earlier. The papule was asymptomatic, but it continued to enlarge and develop over time into an ulcerated plaque. Two additional papules also developed into plaques. The rest of his physical exam was unremarkable. On further questioning, the man explained that he was in the army and had recently returned from a five-month tour of duty in Iraq.

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