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A 70-year-old healthy male presented with a 12-year history of a painful cutaneous vascular lesion on his left shoulder. It had begun as a slowly growing, small, erythematous macula covered by telangiectasias. The pain was triggered by pressure or palpation on the shoulder. Neither cold intolerance nor paroxysmal pain was reported. The patient noticed that symptoms had been increasing in severity over the past two years. Physical examination found a single, well-demarcated, purplish-red dermal nodule, which was 12 mm in diameter.