C. Keloidal scleroderma
In light of the patient’s history of scleroderma, the clinical and histopathologic findings were compatible with keloidal scleroderma, also known as nodular scleroderma, pseudokeloidal scleroderma, keloidal morphea, and nodular morphea.1- 3 Given the patient’s known systemic sclerosis and clinical and histologic findings akin to keloids, we prefer the term keloidal scleroderma for this case. Keloidal scleroderma is a rare variant of scleroderma in which lesions can be morphologically and histopathologically indistinguishable from hypertrophic scar or keloid.1,3,4 Other times, such as in the present case, lesions can appear scarlike but not entirely classic for keloids. Lesions can occur either in sclerotic or nonsclerotic skin and either before or after a diagnosis of systemic sclerosis is made.1,3,4 It is postulated to represent a keloidal response to skin inflammation inherent to systemic sclerosis in individuals already predisposed to keloid formation.2,3,5,6