Review Question - QID 109314

A 58-year-old female presents to her dermatologist complaining of a painful skin rash. She reports that the rash is red, itchy, and peeling. She also reports intermittent fatigue, night sweats, and chills. Her past medical history is notable for hypertension and diabetes mellitus for which she takes lisinopril and metformin. She has previously had two irregular skin lesions removed from her face and neck that eventually were shown to be squamous cell carcinoma. She has a 20 pack-year smoking history and drinks several alcoholic beverages per day. Her temperature is 98.9°F (37.1°C), blood pressure is 140/85 mmHg, pulse is 95/min, and respirations are 18/min. Physical examination reveals a red rash predominantly found on her trunk and thighs, inguinal lymphadenopathy, and hepatosplenomegaly. A notable physical examination finding is shown in Figure A. A biopsy of this patient's skin would most likely reveal which of the following?