A Painful Isolated Skin Lesion on a Man’s Shoulder

Author:
Ronald N. Rubin, MD—Series Editor

Citation:
Rubin RN. A painful isolated skin lesion on a man’s shoulder. Consultant. 2018;58(6):e185.

A 74-year-old man presented for evaluation of a painful skin lesion over his right scapula. The pain and inflammation in the area had worsened since he had first noticed it 5 days prior, and in the past 48 hours, when viewing the lesion in a mirror, he had noted progressive deterioration from a red, swollen area to a lesion featuring central purple-black discoloration with ulceration. There had been no drainage of purulent material. The intensifying pain coupled with the skin changes prompted his seeking medical attention.

He was otherwise quite healthy and quite vigorous for his age. He enjoyed outdoor activities such as hiking, yardwork, and playing competitive softball in various senior leagues. He denied having diabetes, congestive heart failure, or chronic obstructive pulmonary disease, and he was a nonsmoker.

Physical examination revealed normal vital signs—he was and had been afebrile. A lesion of 15 cm in diameter was present over his right scapula. The lesion was basically round, with the central 2 cm being deep purple-black, with ulceration and eschar formation present. The swelling, inflammation, and color faded as one observed from the lesion’s center to its periphery. No other lesions were present anywhere else on the body.

Detailed questioning later revealed that he had traveled from his home near Philadelphia, Pennsylvania, to Cincinnati, Ohio, in the previous week to help a relative empty a house and shed prior to moving, and the symptoms and lesion had first appeared while he was there.