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JAMA Pediatrics Clinical Challenge

Boy With Yellow-Orange, Rough Nodule on Right Thigh

Image of figure 1

Figure 1.

Sara Flores, MD
Jonathan Johnson, MD
Phillip Young, MD
Megha Tollefson, MD

An 8-year-old otherwise healthy boy presented with a yellow-orange, rough nodule on his medial right thigh (Figure 1). It had evolved from a flat discoloration since the age of 3 years, which continued to slowly enlarge and thicken. The patient denied spontaneous bleeding or ulceration, and he had full range of motion and use of his extremity. Neither he nor his family members reported a history of similar lesions on their body. He did not take any medications, had never been hospitalized, and had never had any major surgical procedures. His upper and lower extremities were otherwise normal. On inspection, there was a 4.5 cm × 3.5 cm, verrucous plaque with underlying fullness on the right medial thigh. There were also punctate vessels evident on the hyperkeratotic surface.

See the full article for an explanation and discussion.

Author Affiliations: Flores is affiliated with Rush Medical College, Chicago, Illinois, Johnson is affiliated with the Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, Young is affiliated with the Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota, and Tollefson (tollefson.megha@mayo.edu) is affiliated with the Division of Pediatric Dermatology, Mayo Clinic, Rochester, Minnesota.