A 37-year-old man presented with firm, skin-colored papules and nodules on his back and chest, which had been appearing during the past 7 years (Figure 1a). The patient denied any associated pruritus, pain, or ulcerations. Further history revealed he had a repaired omphalocele during childhood. Physical examination revealed a large body habitus, with asymmetric overgrowth of the right extremities when compared to the left. In addition, the patient had bilateral anterior linear earlobe creases, preauricular pits, and posterior helical pits (Figure 1b). There was no evidence of rheumatologic and endocrine disorders or paraproteinemia.