Unusual Eruption on the Arm: Challenge

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A 38-year-old man presented for evaluation of “bumps” on his right upper arm. The patient denied any symptoms, including systemic symptoms. He had not developed similar lesions elsewhere on his skin.
The patient reported a past medical history of hypertension and denied any history of hyperlipidemia. On physical examination, there were numerous slightly firm, smooth papules and plaques on the right upper arm. A skin biopsy was performed.
Hematoxylin and eosin–stained sections demonstrated a dense proliferation centered within the dermis and composed of histiocytes with ample foamy cytoplasm and a few multinucleated histiocytes. There was also black pigment distributed throughout the foamy cells (Fig. 1A–C).
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