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History

A middle aged man presents with a 9 week history of a lesion over the knuckle of his right index finger. The lesion was initially a slightly tender lump which broke down to form a superficially crusted ulcer with a surrounding rim of erythema. There is no medical history nor history of previous injury to the site, there is no associated lymphangitis or axillary lymphadenopathy, there are no skin lesions elsewhere, and he is otherwise in good health. He works as a clerical assistant and his hobbies include surfing, bushwalking and collecting tropical fish.