A previously healthy 47-year-old man presented a 3-month history of progressive proliferative plaque and ulcer on the dorsal aspect of the right hand. Initially, the patient was bitten by an irritable woman savagely during a dispute on a bus. Bleeding from the wound was stopped by local treatment. Six weeks later, the lesion expanded despite the prescription of irregular oral antibiotics in community hospitals. The patient is heterosexual and denied extramarital sex. On physical examination, the ulcer was brownish-red and 7 to 9 cm in diameter.
