A slow growing elastic papulonodular lesion

A 45-year-old woman presented with a solitary, asymptomatic, slightly elevated violaceous papulonodular lesion with cystic appearance that appeared on her right lumbar region 16 years ago. On examination, it had an elastic and soft consistency (Fig 1). Dermoscopic examination revealed arboriform telangiectasias over a bluish and reddish diffuse area (Fig 2). High-resolution skin ultrasound found a well-defined heterochoic nodule in dermis and hypodermis with negative Doppler signal (Fig 3). Histologic examination showed a lesion in dermis that reaches the papillary and reticular dermis but with no epidermal connection and is formed by basaloid cells forming a palisade in the peripheral cell row (Fig 4, A-C).