Review Question - QID 109496

A 69-year-old man with no significant past medical history presents to his primary care doctor for a travel evaluation. He plans to tour countries in the Middle East and Southeast Asia as part of his post-retirement celebration and requests recommendations on necessary immunizations. He denies any history of venous thromboembolism, previous surgeries, or dependence on any medications. He regularly rows, runs outside, and regularly participates in competitions to stay in shape. His temperature is 97°F (36.1°C), blood pressure is 116/78 mmHg, pulse is 60/min, and respirations are 15/min. Auscultation of his lungs and heart are unremarkable for any unusual rales or murmurs, respectively. His musculoskeletal exam is grossly equal and symmetric bilaterally with no evidence of ataxia on gait assessment. His skin exam is notable for the finding in Figure A. What is the most likely diagnosis?