Does sarcoidosis ever present in the skin without extracutaneous involvement?

Yes. Even though sarcoidosis is defined as a multisystem disorder, some patients present with lesions that are clinically and histologically identical to sarcoidosis without any evidence of involvement of other organ systems. It is possible that some of these patients have involvement of other organ systems but it is minimal and asymptomatic. In other cases, the skin lesions predate the discovery of involvement of other organ systems.