Ulceration of Abdominal Striae Distensae (Stretch Marks) in a Cancer Patient —Quiz Case

A75-year-oldwomanpresentedwitha2-yearhistoryofexquisitely tender ulcerations on her bilateral ankles, which caused pain with ambulation. She had a history of multiple miscarriages, a myocardial infarction at age 60 years, and hypertension. Physical examination revealed stellate purpuric macules, 2 areas of punched-out ulcerations, and 3 white stellate atrophic scars on the left lateral ankle (Figure 1). A 4-mm punch biopsy was obtained from the left lateral ankle (Figure 2 and Figure 3). What is your diagnosis?