Abstract

Clinical Findings
A 68- year-old man presented with a skin thickening of the anterior neck started few months earlier. Upper respiratory and digestive tract had already been examined which proved normal. On clinical examination a hyper pigmented massively indurated leathery plaque was seen on the anterior and lateral aspect of the neck from the submandibular region down to the jugular fossae. The plaque was firm, well demarcated and measured 15 by 12 cm in diameter. It had a cobblestone like appearance with exaggerated folds, and was non painful. Patient complained of a mild discomfort while swallowing saliva of recent onset, but was otherwise asymptomatic. All his routine blood test was normal. The full skin examination was otherwise unremarkable. Our main differential diagnosis at that stage included a reactive process such as a sclerodermatous process, a neoplastic reaction or a lymph proliferative disease.

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