A 14-year-old African American boy presented with a several-year history of multiple asymptomatic nodules on his trunk and arms. The nodules did notgrow or change significantly after they occurred; however, new lesions had developed over the previous year. The patient, who had not had prior consultationor treatment, was otherwise healthy, had no developmental delay, and was of average intelligence. His family history revealed no similar lesions.
On physical examination, 10 nontender dermal nodules, measuring 0.4 to 1.5 cm in diameter, were found on the left arm, trunk, and neck, but onlyon the left side of the body. The overlying epidermis was essentially normal except for slight hyperpigmentation and roughness overlying some of the nodules(Figure 1). No lesions were noted on the tongue, and the findings of the rest of the physical examination wereunremarkable. A punch biopsy specimen was obtained from a representative lesion on the back and stained with hematoxylin-eosin (Figure 2 and Figure 3).