2nd August 2023

A 29 year old pharmacist presents to her GP with a non-healing ulcer. It first started as multiple itchy papules on her cheek.

A 29 year old pharmacist presents to her GP with a non-healing ulcer. It first started as multiple itchy papules on her cheek. She has tried emollients and topical steroids to no effect. On examination, you notice a large, non-tender, indurated ulcer. There are no other lesions. On further questioning, it is established that she had gone on holiday to Guatemala 2 months ago.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.