A 63-year-old woman presents with recent changes in a “rash” on her upper chest and neck that has been present for many years. The rash has become progressively redder and focally irritated. A lesion was “removed” from this area when the patient was a child, and the rash has been there ever since. The patient denies having any other significant health concerns or having other problems with her skin. She has never consulted another health care provider for this skin problem.
Examination shows a 20-cm area of profound skin changes, including atrophy, telangiectasias, erythema, and focal stellate scarring (see Figure 1). There is no ulceration or palpable regional nodes.
Based on the scant clinical information and the problems with the skin itself, you decide to refer the patient. 
The patient should be examined by
- A plastic surgeon
- A general surgeon
- A dermatologist
- An endocrinologist