A healthy 17-year-old boy presented with a 10-year history of skin lesions that initially developed on the right posterior flank. He noted the progressive development of scattered papules and plaques over the upper part of his body that slowly increased in size. The lesions were asymptomatic except for mild discomfort associated with pressure. The family history and the results of a review of the systems were noncontributory.
Physical examination revealed a well-defined, 15 × 1-cm, bluish-purple, nodular plaque over the right flank area (Figure 1). Smaller papules and slightly elevated plaques were present over both arms, the chest, and the upper and lower areas of the back. Numerous, nonpulsatile, flesh-colored to violaceous, tortuous vessels were palpable over the right arm. A biopsy specimen was obtained from the lesion on the right flank area (Figure 2 and Figure 3).
Hamlet KR, Ellis CN, Baltzer R. Diffuse and Progressive Nodular Plaques. Arch Dermatol. 1998;134(7):861-866. doi: