A 45-year-old African American man presented with a long-term history of lesions on his scrotum and buttocks that were occasionally accompanied by pruritus. He reported that the lesions had first appeared when he was 5 or 6 years old and had increased in number throughout his life. Various topical therapies, including corticosteroids, retinoids, and fluorouracil, which had been prescribed by previous clinicians, had cleared some lesions temporarily, but they soon recurred. His medical history was unremarkable, and he denied taking any medications.