Palmar Lesions and a Nonhealing Ulcer of the Ear in a Former Agricultural Worker

REPORT OF A CASE A 58-year-old man, otherwise in good health, presented with a generalized asymptomatic eruption of approximately ten years' duration and a nonhealing lesion involving his right ear. His medical history was significant for alcohol abuse, and it was noted that the patient had worked on a farm with pesticides, fertilizers, and other agricultural products. Physical examination revealed multiple 1- to 2-cm discrete, sharply demarcated, hyperpigmented, rough, flattopped, oval plaques scattered symmetrically on the trunk and upper extremities, including sun-protected areas (Fig 1). In addition, there were several 2- to 3-cm irregularly shaped, well-demarcated, scaling erythematous plaques on the trunk. On the palmar, plantar, and dorsal surfaces of the hands and feet there were multiple 0.2- to 0.5-cm yellow to skin-colored discrete verrucous papules (Fig 2). In addition, a 1.0 × 0.6-cm crusted ulcerated plaque was present in the scaphoconchal region of the right ear (Fig 3). There