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A 14-year-old healthy male was referred to dermatology with three mildly tender, blue papulonodular vascular lesions. The lesions were present on his left knee and right flank (figure 1), which had been present since birth, and he reported developing a lesion on his left scapula within the last 6 months. His mother reported that both she and her father had similar lesions on their leg and forehead, respectively.