She had sustained a deep vein thrombosis (DVT) of the right leg 7 years previously, which had been complicated by recurrent episodes of cellulitis over the ensuing years. Clinicians unaware of this unusual clinical sign may initially be stumped when encountering ENV in black patients for the first time, which could lead to unnecessary skin biopsy in SOC. Dear Editor, A 61-year-old black woman (Fitzpatrick skin type VI) presented with a 3-month history of worsening bilateral leg swelling, with progressive skin changes on the right shin. [Extracted from the article]