A 23-year-old African American woman presented with a dark plaque containing a nodule on her cheek. Although the plaque had been present since birth, a small area of it had become raised over the last 6 months before presentation.
Physical examination revealed a 4.5-cm, well-circumscribed, asymmetrical, verrucous, brown-black plaque on the left preauricular area (Figure 1). A pedunculated nodule arose from the inferior margin (arrow).