A 55-year-old fisherman presented with asymptomatic skin nodules on hands and feet for 2 months, after
repeated exposure to marine organisms, including a recent incident 15 days prior. He gives a history of
removing spines from lesions. Examination revealed multiple, well-defined skin-colored to hyperpigmented
nodules over the dorsa of hands and feet (Fig 1, A). A 37-year-old fisherman presented with similar skin lesions
over both hands for 1 month. The patient reported contact with sea urchins 4 months prior (Fig 2). Examination
revealed multiple, well-defined hyperpigmented nodules over the dorsa of feet (Fig 1, B).
Histopathology revealed well-defined epithelioid cell granulomas with Langhans giant cells (Fig 3, A).
Notably, the second case also exhibited foreign body giant cells (Fig 3, B). Special stains for mycobacteria and
fungi were negative.