Back issues No.3 - 2002 / Resident Forum  

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Multiple Brownish to Black Papules in a 13-year-old Boy
Yi-Ming Huang Woan-Ruoh Lee
Dermatol Sinica 20: 258-259, 2002

Case report
A 13-year-old boy was found to have multiple brownish to black papules over neck, shoulder, abdomen and back since 1995. He was diagnosed with cerebellar medulloblastoma in 1991.Total tumor excision was done. Six courses of adjuvant chemotherapy with vinblastine, VP-16 and cisplatin were administered later. A huge recurrent tumor over the right temporal lobe with mass effect was noted in 1994. The patient underwent total recurrent tumor removal. Adjuvant craniospinal irradiation was given in the subsequent 2 months. No more recurrent tumor was noted during the follow up period. However, multiple brownish to black skin lesions were noted since 1995 which was one year after the completion of radiation. The skin lesions increased in size and number over the next year.
In the physical examination, numerous flesh-colored and brwonish papules were found in the area of the shoulders, abdomen (Fig. 1A), back (Fig. 1B) and neck where the patient had previous irradiation for medulloblastoma. The papules measured about 0.5-1mm in size, some appeared pearly, whereas others were pedunculated in shape similar to skin tags. Multiple tiny pits with hyper- pigmentation were found on the palms. Skeletal anomalies including frontal bossing and mildly increased interorbital distance (Fig. 1A), kyphoscoliosis (Fig. 1B) were also found. Incisional biopsies were done to 2 representative skin lesions on the posterior neck and lower back (Fig 2). Lateral mandible X-ray (Fig. 3) showed a large cyst over the left mandible ramus.

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