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JAMA Dermatology Clinicopathological Challenge
November 2016

Diffuse Progressive Proliferation of Dark Papules in an Otherwise Healthy African American Woman

Author Affiliations
  • 1Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana
  • 2Tulane University School of Medicine, New Orleans, Louisiana
JAMA Dermatol. 2016;152(11):1273-1274. doi:10.1001/jamadermatol.2016.2744

An African American woman in her 30s with no medical history presented with a 4-year history of diffuse progressive proliferation of dark papules. The patient noted that the lesions initially began on her thighs and rapidly multiplied throughout her skin. Some of the lesions were pruritic and when scratched could be removed, leaving behind a hyperpigmented macule. The patient described a sunburn several weeks prior to the initial eruption. She was taking no medications and these lesions were unchanged throughout an uncomplicated pregnancy. There was no personal or family history of melanoma or eruptive nevi. On physical examination, she had hundreds of 1- to 2-mm dark brown-black monomorphic papules throughout her trunk, extremities, palms, face, tongue, and sclera (Figure, A). No lymphadenopathy was present. Findings from laboratory tests, including a complete blood cell count, comprehensive metabolic panel, and computed tomography of the chest, were unremarkable. A punch biopsy was performed for histopathologic examination (Figure, B-D).

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