Fleshy Papules in Areas of Friction in a Man With Endocrine Neoplasms—Quiz Case

A 39-year-old African American man presented with a progressive eruption of fleshy papules on his neck, axillae, groin, and abdomen. The lesions first developed on his neck in his mid-20s and slowly progressed to involve other sites. They occasionally bled when traumatized. His more recent medical history was remarkable for multigland parathyroid hyperplasia, pituitary microadenoma, and neuroendocrine pancreatic tumors. Physical examination revealed dozens of 2to 10mm, flesh-colored to brown, pedunculated, verrucous papules located circumferentially around the neck (Figure 1), extending down to the anterior aspect of the chest, and in the axillae and bilateral groin folds. Scattered across the lower area of the abdomen, there were numerous hypopigmented to flesh-colored 4to 10-mm dome-shaped firmer papules (Figure 2). A 2-cm lightbrown patch was observed on the left upper arm area. There was also mild freckling around the posterior axillary folds. Punch biopsy specimens were obtained from a pedunculated papule on the neck and a dome-shaped papule on the abdomen. What is your diagnosis?