A 46-year-old man presented with longstanding ulcerative lesions on his lower leg. Rather than oral medication, he preferred pimecrolimus 0.1% ointment and clobetasol gel 0.05% applied twice a day. This decreased his pain but did not lead to resolution of the lesions. He also received benefit from a 3-cc injection of intralesional kenalog with a concentration of 2.5 mg/cc. The patient did not have any associated bowel symptoms, and a colonoscopy was normal. He did not have arthritis of any type, although the lesions made ambulation difficult.
A man in his mid-40s with no history of skin cancer presented with a painless forearm lesion that did not itch or burn. This erythematous keratotic papulo-nodule was growing rapidly and had appeared approximately one month earlier. The patient suspected a spider bite or infection. When he was younger, the patient had been subjected to a great deal of sun exposure. A biopsy showed well-differentiated squamous epithelium with pleomorphism and large cells at the core with surrounding hyperplasia in a craterlike pattern..