Leprosy is an infectious disease caused by Mycobacterium leprae. Patients usually present with hypopigmented or erythematous plaques with central hypoesthesia or tenderness, and necessitate a differential diagnosis with eczema, granuloma annulare, sarcoidosis, syphilid, mycosis fungoides, erythema nodosum, and skin cancer. A 93-year-old woman presented with asymptomatic erythematous plaques and subdermal nodules on the face and extremities for 6∼ 7 months, and the lesions were suspicious for skin cancer. Histopathologic examination revealed diffuse infiltration of foamy histiocytes separated by a grenz zone. Acid-fast bacilli were seen in Ziehl-Neelsen stain with clumps called globi. Based on clinical and histopathological findings, she was finally diagnosed with lepromatous leprosy. The patient was diagnosed with leprosy at an advanced age; thus, we report the case in which dermatologists should consider leprosy as well as skin cancer in the elderly patients with unusual erythematous nodules, despite decreasing prevalence of leprosy. (Korean J Dermatol 2020;58(7):487∼488)