Multiple Smooth Skin Nodules

REPORT OF A CASE A 61-year-old white man presented in 1985 with persistent sacral pain that was first attributed to arthritis. The pain worsened and a computed tomographic scan revealed a sacral mass. Surgical excision followed by radiation therapy was performed. The mass recurred locally and reexcision was performed in 1990. In 1991, skin lesions began appearing. The skin growths expanded rapidly. The photograph shown in Figure 1 was taken in 1992. The photograph in Figure 2 was taken in 1993, approximately 1 year later. A biopsy specimen was obtained ( Figure 3 and Figure 4 ). What is your diagnosis? DIAGNOSIS: Chordoma cutis. HISTOPATHOLOGIC FINDINGS Hematoxylin-eosin—stained sections (Figure 3 and Figure 4) demonstrated a diffuse neoplastic process that was partially encapsulated. The neoplasm was composed of numerous lobules and nests of large polygonal cells that were progressively compartmentalized by fibrous septae. Characteristic physaliphorous cells, which are large multivacuolated polygonal cells, some of which