Semi-firm lesions on the flanks and extensor surfaces

An otherwise healthy Nigerian man in his 20s presents with pruritic lesions that progressed over the past18 months.He reports the lesions started as a few grouped bumps on the flank that quickly spread over most of the torso.He denies preceding trauma.Due to the COVID-19 pandemic, his initial visit, 6 months prior to his clinic visit, was done through video, when he received fluocinonide ointment for presumed keloids.On exam, pink-brown, semi-firm, domeshaped papules and nodules were arranged in a curvilinear array along the flank with an advancing scaly border (Figure 1A).Additionally, semi-firm, flat topped plaques with overlying scale were noted on the left dorsal hand, left upper arm (Figure 1B), and ankles.The remaining examination was normal.Shave biopsy of a flank papule was performed (Figures 2,3).Question 1: Based on this patient's history and exam findings, what is the most likely diagnosis?A. Cutaneous lymphoma B. Sarcoidosis C. Keloid scars D. Leprosy E. Leishmaniasis Answers: A. Cutaneous lymphoma -Incorrect.Cutaneous lymphoma can be considered clinically with various clinical presentations, including nodules as seen in this patient.However, the histology of lymphoma would demonstrate large aggregates of atypical lymphocytes