Review Question - QID 108531

A 63-year-old man comes in with a new-onset rash on his back. He is accompanied by his wife, who mentions that the “spots” gradually started appearing over the last three months. She forced him to come in because her sister had just been diagnosed with malignant melanoma and she wanted to make sure his rash wasn't cancer. The patient does not report any other symptoms except for mild seasonal allergies. The patient has no other medical problems except for a recent diagnosis of stage I hypertension, which he is attempting to control with diet and exercise. He states that he has successfully lost ten pounds in the last two months. The patient works as a bus driver and enjoys gardening in his free time. He does not smoke or drink alcohol. His temperature is 98.2°F (36.8°C), pulse is 65/min, respirations are 12/min, blood pressure is 142/94 mmHg, and BMI is 31 kg/m². On exam, the patient demonstrates numerous brown and black pigmented papules and plaques on his back with waxy scales as shown in the Figure A. Which of the following conditions is most likely associated with this presentation?