A 37-year-old male with no relevant past medical history, had a 5-year work history as a farmer in the Colombian Amazon River area, and presented with a 2-year history of a nodular, hyperpigmented lesion on the dorsal region of the left hallux, which progressively increased in size, ultimately resembling a tumor-like keloid lesion, but without any pain, fever or systemic symptom related. On physical examination the only positive finding was a large, smooth and shiny surface, painless nodular keloid-like lesion, measuring 7 × 5 cm on the dorsal surface of the left hallux (Fig. 1 - Panel A), along with three other lesions measuring around 1 × 1 cm, distributed linearly in the medial region of the left lower limb.
