A 56-year-old Caucasian female presented to the dermatologist's office with complaints of a painful, red papule on the her left proximal arm that has gradually enlarged in size over the past year. She reports that the pain in the lesion is sharp, and brought on by touch or cold air. She describes many similar smooth, pink papules on her chest and proximal arms, which have gradually increased in size and number over the past 2 decades.

She has a past medical history significant for multiple uterine fibroids requiring hysterectomy at age 32 years. Her mother also had a history of uterine fibroids, and similar painful skin lesions on her chest and arms.

On physical exam, the patient had an 8 mm pink, smooth, and firm papule on her proximal left arm, which was markedly painful on light palpation. Several pink, firm papules were also present on her chest, with variable tenderness.