Fig 1.
A well-defined moderate severity verrucous violaceous plaque, raised edges, measuring 4.5 × 3.0 cm with central ulceration and black dots in the periphery.
Fig 2.
Dermoscopy shows black dots (black arrow), shiny white blotches and strands (white arrows), and yellowish-orange area (blue arrow).
DermLite IV DL4; 3 Gen, polarized mode, ×10 magnification.
Fig 3.
Reflectance confocal microscopy (basic image 0.5 × 0.5 mm) at the level of the stratum corneum and epidermis evidencing 2 small round hyperreflective bodies. VivaScope 1500.
Fig 4.
High-frequency ultrasound with Doppler shows epidermal thickening, hyperechogenic round structures (arrow), dermal fibrosis, and increased vascularization.
My Lab Touch, 22 MHz linear transducer.
Fig 5.
Histopathology of a skin biopsy reveals grouped fungal structures encircled by a granulomatous infiltrate in the dermis.
HE, ×400.