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An asymptomatic annular patch on the palm

A 69-year-old white man presented with a 30-year history of a solitary, asymptomatic lesion on his right palm. The lesion had gradually increased in size over the years, but did not cause the patient any discomfort. His medical history included recurrent otitis since childhood, nonspecific hepatitis at the age of 7 years, and treated prostatic hyperplasia. Five years previously, the patient had undergone systemic treatment with antimycotics for onychomycosis involving his toenails; this treatment had no effect on the palmar patch. On physical examination, a well-circumscribed, rounded, slightly depressed erythematous patch, 25 9 8 mm in size, was seen on the thenar eminence of the patient’s right palm. (Fig. 1). A biopsy lesion was taken from the margin of the lesion for further examination.