An asymptomatic flesh-colored tumor on the dorsal hand

A 61-year-old male with a history of coronary artery disease, osteoarthritis, asthma, schizophrenia, and intellectual disability presented to a dermatology clinic for evaluation of a lesion later diagnosed as a pyogenic granuloma.Further exam revealed a bland 2.5 cm flesh-colored tumor on the dorsal left hand, present for approximately 10 years (Fig 1).A shave biopsy demonstrated a polypoid portion of skin with dermal proliferation of atypical spindled to bizarre pleomorphic cells extending into thickened subcutaneous septae (Fig 2).Higher power magnification revealed subcutaneous lobules containing large pleomorphic lipoblasts with atypical mitotic figures (Fig 3).