September 2007

Fig.1

Fig.2

History: An 80yo Caucasian male with severe COPD presents with a growing nodule on his left upper arm which he stated "began as a blackhead 5 years ago". The patient denied pruritus or pain but reported a brown, foul-smelling drainage for 5 days. He had lost 30lbs over 5 years.

Past Medical History: HTN, COPD

Medications: Metoprolol, theophylline, and inhalers.

Social History: 65 pack-years of tobacco.

Physical Exam:
Left upper arm: 3.5cm pedunculated, lobular, firm, red nodule (Fig.1) with dark serous discharge
Left axilla: two non-tender, firm, mobile, enlarged lymph nodes (Fig.2)

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