A 79-year-old white woman presented for evaluation of hyperkeratotic nodules and plaques on the lower part of her left leg. The lesions had been present for approximately 5 to 7 years. The lesions had rapidly increased in both size and number over a period of several months. A skin biopsy specimen that had been obtained at an outside institution was interpreted as well-differentiated squamous cell carcinoma (SCC), prompting the patient's referral to our institution for treatment.

On physical examination, there were clusters of hyperkeratotic to verrucous papules and nodules on an erythematous base. There was a coalescence of lesions forming large plaques over the lateral aspect of the lower part and pretibial area of the left leg (Figure 1). The affected area measured 17 × 9 cm in greatest dimension. Rare smaller, discrete, 5- to 7-mm violaceous papules were noted at the periphery of the larger plaques. Examination of the inguinal region and popliteal fossa revealed no lymphadenopathy. The findings of examination of the patient's nails, hair, and oral mucosa were normal.