A Woman With a Large Ulcerated Nodule on the Finger

Abstract

A 59-year-old black woman with a history of hypertension, hyperlipidemia, and type 2 diabetes presented with a 2-month history of a rapidly enlarging tender nodule on her right fifth digit. She denied fevers, joint pain, joint stiffness, inciting trauma, or recent outdoor activity. She had no history of immunosuppression. Results of a recent complete blood cell count and comprehensive metabolic profile were unremarkable. Physical examination showed a single 25-mm, firm, dome-shaped subcutaneous nodule with central ulceration on the lateral aspect of the right fifth digit (Figure 1). There was no erythema, edema, fluctuance, induration, or lymphangitis surrounding the lesion. No lymphadenopathy was present. Diagnosis Merkel cell carcinoma What to Do Next