An Acquired Vascular Lesion in a Child

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Abstract
REPORT OF A CASE A 9-year-old boy presented with a 1-year history of an asymptomatic brown papule on the medial aspect of his right knee. He was otherwise healthy, and his mother could not recall an insect bite or trauma to the involved skin. The pinpoint-sized lesion began to slowly enlarge. Pruritus or blistering of the lesion was not associated. He denied systemic symptoms such as flushing, palpitations, syncope, nausea, vomiting, or diarrhea. Physical examination revealed a healthy-appearing boy in no apparent distress. On the medial aspect of his right knee was a violaceous macule (diameter, ±2×1 cm) with a central, slightly indurated brown papule (diameter, 0.3 cm) (Figure 1). The overlying epidermis appeared thickened and did not urticate on firm stroking. The skin surrounding the papule appeared faintly violaceous. Inguinal lymph nodes were not palpable, and the remainder of his examination was unremarkable. A punch biopsy specimen of the

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