Shoulder Fungating Mass

A 31-year-old Micronesian Man With Shoulder Fungating Mass: A 31-year-old male, from the Island of Chuuk (Micronesia), presented to our service with a large fungating shoulder mass. The mass originated 1 year ago as a blister-like lesion at the site of a prior tattoo and slowly expanded to encompass most of the shoulder. The lesion was intermittently painful and without dysesthesia. He lived in Missouri for the past 8 years after emigrating from Guam at age 23. He previously worked in construction and at a chicken processing facility. He denied prior history of incarceration, homelessness, or family contacts with known tuberculosis. He denied local trauma, intravenous drug abuse, breaks in the skin, or new tattoos prior to the start of the rash. Several years prior to the onset of his symptoms, a nonprofessional tattoo artist in Guam created a tattoo on his shoulder. He reported an uncertain amount of weight loss over the prior year with anorexia but denied cough, shortness of breath, or hemoptysis. After the rash started, he traveled back to Guam and reported no other travel.