Ulcerated Nodules and Papules on the Neck and Chest

REPORT OF A CASE  A 43-year-old black woman presented with a 2-month history of pruritus and a skin eruption that began as papules on her chest. She denied any constitutional symptoms, and a review of symptoms proved noncontributory. Physical examination revealed a 9×11-cm ulcer with undermined margins on the anterior aspect of the left side of her chest (Figure 1 ). There were scattered papules and nodules surrounding the large ulcerated area. No vesicles were seen. Fistulous tracts were noted in the area of the left posterior cervical lymph node chain. It appeared that the ulceration originated from enlarged nodes. The results of viral and bacterial cultures were negative. No clinical response to both antiviral and antibacterial therapies was appreciated. A dermatology consultation was requested, and an incisional biopsy was performed at the leading edge of the ulcer. The histologic features of the biopsy specimen are shown in Figure 2.What