Image of the Week: Numerous Pruritic, Keratotic Lesions on the Back and Neck

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A 62-year-old woman presents with fatigue and innumerable pruritic, keratotic lesions on her back and neck that developed rapidly 2 months earlier. Laboratory blood testing reveals microcytic anemia with a hemoglobin level of 9.1 g/dL. What is this patient’s most likely underlying condition?

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