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Am Fam Physician. 2024;109(5):465-466

Author disclosure: No relevant financial relationships.

A 68-year-old woman presented to the dermatology clinic with persistent lesions on her trunk and extremities. Two years earlier, she had consulted her primary care physician regarding four scattered “lumps,” which she attributed to mosquito bites. Two years later, she was seen by a different primary care physician when she developed discoloration on her arm, which she believed was related to an aspirin allergy. The patient was seen twice more over the following 3 months before referral to the dermatology clinic.

The patient had a history of breast cancer 30 years previously, which was treated with radical mastectomy, chemotherapy, and radiation. She also had a history of controlled hypertension, type 2 diabetes mellitus, and an allergic reaction to iodine contrast media.

Examination revealed multiple firm, painless, hyperpigmented plaques scattered across her trunk and extremities (Figure 1). The plaques contained central pink nodules.


Based on the patient's history and physical examination, which one of the following is the most likely diagnosis?

  • A. Angiosarcoma (Stewart-Treves syndrome).

  • B. Cutaneous metastasis from breast cancer.

  • C. Discoid lupus erythematosus.

  • D. Fixed drug eruption.

  • E. Keloids.

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This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

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