The patient is a 47 year old Caucasian female with a two month history of asymptomatic "bumps" on her extremeties. Several years previously she had tripped and fell on an asphalt driveway. Physical exam revealed the presence of multiple, moderately tender, skin colored to slightly erythematous nodular lesions, on both the upper and the lower extremeties. Several of these nodular lesions can be seen in the figure of the posterior aspect of the right arm. Initial laboratory studies that included a CBC, SMA 16, and a chest X-ray, were within normal limits.

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