A 38-year-old man was seen with a 1-year history of a 1.2-cm painful crusted plaque on his left upper arm. The surrounding skin and subcutaneous tissues were atrophic, with prominent telangiectasia extending in a zosteriform distribution from the left posterior shoulder down onto the left dorsal forearm and hand (Figure 1). The reticulated vascular pattern had been present since childhood. The patient was not certain if it had been present since birth, and there are no photographs of him as an infant. He had no limb asymmetry and no other skin abnormalities. His medical history was significant only for hypertension.