Intended for healthcare professionals

Endgames Case Review

A mass on the shin

BMJ 2019; 366 doi: (Published 12 September 2019) Cite this as: BMJ 2019;366:l4822
  1. Stamatis Gregoriou, consultant dermatologist,
  2. Anastasia I Petra, resident dermatologist,
  3. George Kontochristopoulos, consultant dermatologist
  1. First Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, Andreas Syggros Hospital, Athens, Greece
  1. Correspondence to S Gregoriou stamgreg{at}

A 55 year old white woman presented with a mass on her shin. It had been present for six months and had an exophytic growth pattern. She reported a history of psoriasis for the past 13 years, for which she had received ciclosporin, a T-lymphocyte immunosuppressant, intermittently for the first 12 years (3 mg/kg for six months each year), and secukinumab, a human monoclonal antibody against interleukin 17A (IL-17A) (300 mg every four weeks), for the past 12 months. She did not report increased sun exposure or use of a tanning bed.

Physical examination revealed a 5×4 cm growth, sparsely scattered with micro-haemorrhages and crusts (fig 1). Popliteal and …

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