Seamus, a 12-year-old boy, attends with his father for review of multiple papillomatous brown plaques on the neck that have been present for two weeks.

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<p>Seamus, a 12-year-old boy, attends with his father for review of multiple papillomatous brown plaques on the neck that have been present for two weeks.</p><p>There is no associated itch or pain and no previous history of inflammation or trauma to the sites.</p><p>Seamus is otherwise well, with no significant past medical history.</p><p>His father reports Seamus maintains good, regular hygiene practices.</p><p>On examination, vital signs are within normal limits. The only clinical finding of note is several thickened, brown-black plaques on the neck.</p><p>Dermatoscopy reveals multiple brown polygonal granules with a cobblestone pattern (pictured left — a).</p><p>When wiped with soap and water, there is no change to this appearance, but the plaques were partly removed with an alcohol swab (pictured right — b).</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.