A Growing Scar on the Abdomen of a Middle-aged Woman

Abstract

Awoman in her 50s presented for evaluation of a growing, painful scar on the right side of her abdomen. She reported having a rectangular area of discolored skin for the past 10 years that developed as a result of a complication during an interventional radiology procedure for treatment of a splenic aneurysm. Two months prior to presentation this lesion became painful and enlarged, without improvement with triamcinolone cream or oral antibiotics. She also reported recent fevers, night sweats, nausea, and fatigue. She denied international travel, drug use, incarceration, and high-risk sexual behavior. The patient had a history of uterine cancer at age 25, for which she underwent hysterectomyandchemotherapy. Shealsohadahistoryofbreast cancer inher40s, forwhich she underwent lumpectomy and tamoxifen therapy. She had undergone surgical excision of a gastric polyp in her early 50s. She had no history of radiation therapy. On physical examination she was well-appearing and afebrile, with normal vital signs. There was a 12 × 7–cm indurated pink and deep purple plaque on the right side of the abdomen,with 2 focal areas of ulceration (Figure). Extending outward from this plaquewere finger-like projections of purple subcutaneous papules. Inferior to the plaque therewas an approximately 3-cm, tender, orange-to-yellow patch. No lymphadenopathy or other skin lesions were noted. Quiz at jama.com Figure.Growing lesion on patient’s abdomen.