A man aged 53 years presented to a general practitioner (GP) with a 1–2-month history of a rapidly increasing skin growth on his right medial ankle. It had become tender and bled readily on contact. He had a history of right leg venous insufficiency, with three previous venous ulcers in the same location as the new skin lesion. The venous insufficiency was being managed with a class 2 compression stocking. He had no history of skin cancer. On examination there was a 3.5 cm × 3.5 cm exophytic, friable skin growth with a crusted rim over his right medial malleolus (Figure 1). His leg showed chronic changes of venous insufficiency. There was no palpable lymphadenopathy of the affected leg and groin, and no palpable hepatosplenomegaly.