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November 2012

Fleshy Papules in Areas of Friction in a Man With Endocrine Neoplasms—Quiz Case

Author Affiliations

University of Michigan Medical School, Ann Arbor

Arch Dermatol. 2012;148(11):1317. doi:10.1001/archdermatol.2012.2277a

A 39-year-old African American man presented with a progressive eruption of fleshy papules on his neck, axillae, groin, and abdomen. The lesions first developed on his neck in his mid-20s and slowly progressed to involve other sites. They occasionally bled when traumatized. His more recent medical history was remarkable for multigland parathyroid hyperplasia, pituitary microadenoma, and neuroendocrine pancreatic tumors.

Physical examination revealed dozens of 2- to 10-mm, flesh-colored to brown, pedunculated, verrucous papules located circumferentially around the neck (Figure 1), extending down to the anterior aspect of the chest, and in the axillae and bilateral groin folds. Scattered across the lower area of the abdomen, there were numerous hypopigmented to flesh-colored 4- to 10-mm dome-shaped firmer papules (Figure 2). A 2-cm lightbrown patch was observed on the left upper arm area. There was also mild freckling around the posterior axillary folds. Punch biopsy specimens were obtained from a pedunculated papule on the neck and a dome-shaped papule on the abdomen.

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