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JAMA Dermatology Clinicopathological Challenge
July 24, 2019

A Firm Plaque on the Occipital Scalp

Author Affiliations
  • 1Department of Dermatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
  • 2Department of Dermatology, Linyi People’s Hospital, Linyi, China
  • 3Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston
JAMA Dermatol. Published online July 24, 2019. doi:10.1001/jamadermatol.2019.1972

A man in his 20s presented with a 6-year history of multiple growing papules superimposed on an asymptomatic firm plaque on the occipital scalp. The lesions were never ulcerated or inflamed, but hemorrhage occurred occasionally after rubbing. At 3 years of age, scarlike macules appeared on the occipital scalp and coalesced to form a larger plaque with sparse hair. Simultaneously, multiple brown-red, dome-shaped papules developed on the nose and gradually evolved to involve the cheeks. Rubbery plaques also developed on the sacrococcygeal area, along with hypopigmented patches on the right buttock. The patient has no systemic symptoms or mental impairment and denied a family history of genetic disease.

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