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What is this pigmented papule on a toddler's shoulder?

What is this pigmented papule on a toddler's shoulder?

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(Answer on next page.)

Case 1:
The mother of this 18-month-old boy brings him to your office for evaluation of a pigmented lesion of 2 months’ duration on the right anterior shoulder. When the lesion is rubbed, it becomes red and inflamed and occasionally a blister forms. The child is otherwise healthy.

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