A Huge Plaque on the Back: A Quiz

A previously healthy 44-year-old woman presented to our department with a skin lesion on her back. The lesion presented as multiple, variable-sized, skin-coloured to tan-grey, papules, focally coalesced into a huge plaque (15.5×7 cm) with a grouped distribution on her lower back (Fig. 1). The surface of the lesions presented a prominent granular appearance. The papules had appeared in early childhood, increased in number, and progressively enlarged and coalesced into a huge plaque with large amounts of grey granules on the surface. She had no family history of similar lesions, and no other physical or systemic abnormality.