A 79-year-old otherwise healthy Puerto Rican woman is seen for a 3-month history of a rapidly enlarging mass on her right foot. The involved areas are occasionally tender, affecting her ability to walk. Physical examination reveals many confluent, deep red to purple, eroded, grapelike nodules affecting all aspects of the foot and extending to the distal part of the leg. The largest confluent mass is on the heel extending to the posterior side of the ankle. She has no history of immunosuppression.