Enlarging verrucous plaque in a Guatemalan male

Abstract

A 43-year-old man is being evaluated for intractable pain from an enlarging plaque of 10 years' duration on his left knee. He emigrated from Guatemala 6 months ago and previously worked as a farmer and forklift driver. Originally focal, the lesion progressed to encompass the entire knee, medial leg, and distal thigh. Prior treatment with topical triamcinolone provided no benefit in reducing lesion size or symptoms. Physical examination demonstrates a 30 × 40–cm, indurated, verrucous plaque with central scarring, scalloped borders, and overlying white adherent scale (Fig 1).