A large fungating skin lesion in an elderly nursing home resident

Case: A nursing home resident aged 80 years presented for an influenza vaccination when he was noted to have a large fungating lesion with rolled edges on his right chest (Figure 1). The lesion was believed to have been present for many months. There was no history of preceding trauma or insect bite, recent travel or immunosuppression. His past medical history was significant for moderate dementia, hypertension, hypercholesterolaemia, benign prostatic hypertrophy, osteoarthritis and alcoholic liver cirrhosis. His medications included dutasteride/tamsulosin, escitalopram, frusemide, perindopril, propranolol and thiamine. He was a retired bricklayer of Scottish heritage with an eight pack-year smoking history.