A 15-year-old African-American man (Fitzpatrick skin type V) presented to the outpatient dermatology clinic with a large, verrucous, exophytic mass measuring 3.5 × 2.3 cm on the right lateral side of the posterior flank (Figure 1). The lesion had been increasing in size for several years. His mother had refused a shave excision when he was 9 years old. He also had atopic dermatitis, acanthosis nigricans, and benign melanocytic nevi. He was obese with borderline hypercholesterolemia.
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