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Palisaded neutrophilic and granulomatous dermatitis and interstitial granulomatous dermatitis are uncommon granulomatous dermatoses that often arise in association with rheumatoid arthritis. These 2 entities have overlapping features and may exist on a spectrum. We report an intriguing case of a 53-year-old man with advanced rheumatoid arthritis who presented with a large indurated painful truncal plaque with a palpable cord in addition to a papulonodular eruption on his dorsal hands. Furthermore, our patient had a recurrence in a near-identical mirror-image pattern on the contralateral trunk. The constellation of clinical and histopathological findings in our patient further suggests that palisaded neutrophilic and granulomatous dermatitis and interstitial granulomatous dermatitis exist as overlapping disease entities on a continuum. In addition, we propose that recurrence of skin findings may be indicative of the severity of the underlying systemic disease process.

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Eligible for 1 MOC SA Credit From the ABD This Photo Challenge in our print edition is eligible for 1 self-assessment credit for Maintenance of Certification from the American Board of Dermatology (ABD). After completing this activity, diplomates can visit the ABD website (http://www.abderm.org) to self-report the credits under the activity title "Cutis Photo Challenge." You may report the credit after each activity is completed or after accumulating multiple credits.An 80-year-old man presented to our clinic with a large lesion on the right upper neck of approximately 4 weeks' duration. He reported that it was rapidly increasing in size and had bled on several occasions. No treatments were attempted prior to the initial visit. He denied any constitutional symptoms. The patient had a history of nonmelanoma skin cancers but no other chronic medical problems. Physical examination revealed a large, 35×40-mm, erythematous nodule with central ulceration and overlying hyperkeratosis on the right upper neck. No palpable cervical, supraclavicular, or axillary lymphadenopathy was observed. An excisional biopsy of the lesion was obtained. WHAT'S YOUR DIAGNOSIS?a. atypical fibroxanthoma b. basal cell carcinoma c. keratoacanthoma/squamous cell carcinoma d. Merkel cell carcinoma e. primary cutaneous anaplastic large cell lymphoma

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