A man presents with three annular lesions that have central areas of diminished sensation. What are these lesions and how should they be treated?
Over a two-year period, a 54-year-old missionary developed on his trunk three persistent, annular lesions measuring up to 5 cm in diameter. Each lesion had an elevated, oedematous, serpiginous border that had slowly migrated, leaving a central pale area that had diminished sensation (Figure 1). Skin biopsy from the annular border revealed multiple dermal granulomas with admixed lymphocytes and occasional plasma cells. Nerves in the deep dermis were inflamed (Figure 2).