Clinical Manifestations Lesions are usually single and begins as firm, painless, nontender, movable, subcutaneous nodules 1 to 2 cm in diameter.
Many patients complain of itching in the lesion.
In 1 or 2 months, the nodule may become fluctuant and ulcerates, with an undermined edge that often extends 15 cm or more. The skin adjacent to the lesion, and often that of the entire corresponding limb, may be indurated by edema. Ordinarily, no regional lymphadenopathy or systemic manifestation are noted. There is, however, speculation that massive disseminated lesions may cause systemic toxic effects. Ulcers may remain small and heal without treatment, or may spread rapidly, undermining the skin over large areas, even an entire leg, thigh, or arm.