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JAMA Pediatrics Clinical Challenge
January 2018

Rapidly Changing Skin Lesion in a Teenage Boy

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Boston Children's Hospital Dermatology Program, Boston, Massachusetts
JAMA Pediatr. 2018;172(1):87-88. doi:10.1001/jamapediatrics.2017.3242

A 16-year-old boy presented with a changing skin lesion on his right lower back. The patient reported the presence of a stable red lesion since he was 7 years old; however, over the preceding month, this lesion developed new black spots within it. There was no associated pain, pruritus, or bleeding. His family history was notable for dysplastic nevus syndrome in his father and melanoma in a paternal uncle and cousin.

On examination of the right lower back, there was a cluster of 1-mm flat purple-black papules coalescing into a 1.5 × 1.0-cm oval plaque with surrounding erythema (Figure, A). On reinspection of the lesion at a subsequent visit, the morphology had significantly changed; there were 1-mm skin-colored to pink thin-walled vesicles clustered within a 1.5 × 1.0-cm oval telangiectatic plaque (Figure, B).