Lax Skin Masses in a 47-Year-Old Woman—Quiz Case

A 47-year-old black woman presented with progressive asymptomatic skin lesions of more than 5 years’ duration. Physical examination revealed lax skin masses on her neck (Figure 1) and trunk, the upper part of both arms (Figure2), and the inner area of both thighs. There was a large indurated plaque on her abdomen and ulcerated tumoral lesions on her arms and legs. The lymph nodes were not enlarged. The results of routine laboratory tests (ie, complete blood cell count, erythrocyte sedimentation rate, liver function, and serum amylase, lactate dehydrogenase, calcium, electrolyte, total serum protein, urea, and creatinine levels) and radiography of the chest were all within the normal range. A biopsy specimen was obtained from the right upper arm area (Figure 3 and Figure 4). What is your diagnosis?