A nurse practitioner asks for an opinion regarding a skin lesion on a 39-year-old African American man. The lesion is located on the inner left thigh and is mildly pruritic. It measures an irregular 11 cm × 8 cm and is shiny and smooth with irregular areas of roughness.

There is no drainage or redness. The patient says that he first noticed the lesion a few months ago and did not think much of it, but it has been growing. Laboratory workup and physical examination were negative for abnormalities.

After consultation with dermatology, clinicians performed a punch biopsy, which revealed a diagnosis of mycosis fungoides, or cutaneous T-cell lymphoma. Biopsy is mandatory for a proper diagnosis, as well as staging of the disease. The patient was subsequently referred to oncology for further management. (198-6)

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