Woman With Left Shoulder Bumps James Fitzgibbon, MD, Jonhan Ho, MD, Michele Dorfsman, MD  Annals of Emergency Medicine  Volume 69, Issue 4, (April 2017) DOI: 10.1016/j.annemergmed.2016.11.001 Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 1 Red, raised, inflamed, and indurated approximately 2-cm-diameter lesion over the right anterolateral aspect of the neck. Annals of Emergency Medicine 2017 69, DOI: (10.1016/j.annemergmed.2016.11.001) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 2 CT of the chest (axial view), with arrows indicating suspected metastatic lung nodules. Annals of Emergency Medicine 2017 69, DOI: (10.1016/j.annemergmed.2016.11.001) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 3 Low-power (4×) view of the lesion showing significant abnormal cell proliferation (arrow) beneath normal dermis (arrowhead). Annals of Emergency Medicine 2017 69, DOI: (10.1016/j.annemergmed.2016.11.001) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 4 High-power (40×) view of the lesion demonstrating proliferation of atypical cells with abundant eosinophilic, vacuolated cytoplasm (arrowheads) and large nuclei with prominent nucleoli (arrows). Annals of Emergency Medicine 2017 69, DOI: (10.1016/j.annemergmed.2016.11.001) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 5 High-power (40×) view of the lesion showing that S100 immunohistochemical stain results (arrowheads) on these samples were positive. Annals of Emergency Medicine 2017 69, DOI: (10.1016/j.annemergmed.2016.11.001) Copyright © 2016 American College of Emergency Physicians Terms and Conditions