ABSTRACT
This chapter presents a case study of a 23-year-old woman who visits the GP practice nurse because of persistently high blood pressure. During the course of her discussion she mentions incidentally that she is cosmetically troubled by ‘lumps’ on her skin, which leads the nurse to refer her to the dermatology clinic. She describes the lumps as asymptomatic but gradually accumulating, particularly over her trunk. She is otherwise well and on no medication. Her parents and sister are also well with no history of hypertension, coronary artery disease or similar skin lesions. She has an unusual pigmentary pattern with generalized freckling or lentigines affecting non-sun-exposed sites (such as inframammary, axillae and groin) as well as sun-exposed sites. She also has soft, fleshy, non-tender, pink to skin-coloured smooth nodules, some of which protrude and are pedunculated and some are located deeper within the dermis. She has normal heart sounds, but she does have a clearly audible right-sided abdominal bruit.
