This image depicts a close view of a patient’s shoulder, which had manifested a lesion during the primary stage of syphilis, which was diagnosed even after receiving a negative dark field examination of the patient's penile lesion, pictured in PHIL 17035, and 17882. Every genital lesion should be considered syphilitic until proven otherwise. Extragenital lesions characterized by indolence, induration, and regional lymphadenopathy, should be regarded as possibly syphilitic. Failure to find the Treponema pallidum bacterium does not exclude a diagnosis of syphilis. This image was captured at an earlier stage that was depicted in PHIL 6728.