Multiple Craniofacial Nodules and Plaques Distributed Bilaterally Along Blaschko Lines

A male in his late teens presented with asymptomatic congenital papules, plaques, and nodules in a linear bilateral distribution following Blaschko lines on the scalp and face region. The papules and nodules appeared to grow as the boy grew, and some pedunculated lesions tended to fall off spontaneously. He had not received any prior treatment. The patient had no other significant medical history and denied having a family history of similar lesions. Clinical examination findings revealed multiple skin-colored, nontender soft papules of varying sizes protruding from the skin surface on the right cheek, forehead, and jaw, as well as on the anterior surface of the scalp, distributed along Blaschko lines, with sparse vellus hairs and multiple hair follicles on the lesions (Figure, A and B). However, no hair was observed on the lesion because the patient had shaved the hair on his face. An incisional biopsy of a pedunculated lesion above the left eyebrow was performed (Figure, B).