History: 66 year-old white female with an extensive past medical history of benign and malignant tumors. The patient had a partial thyroidectomy for goiter at age 28 and completion thyroidectomy at age 39. She had a mastectomy for left-sided breast cancer at age 46. At 49 she had a total abdominal hysterectomy with bilateral salpingo-oophorectomy for uterine adenocarcinoma. At age 59 she had a right partial nephrectomy for renal cell carcinoma. In her early 60s brain MRIs to work up chronic severe headaches revealed two stable frontal meningiomas. At age 66 she was diagnosed with invasive ductal carcinoma of the right breast and underwent right mastectomy.

Dermatologic history includes skin colored papules on her face and multiple lesions biopsied from her tongue and oral mucosa showing squamous papillomas. She also had a sclerotic fibroma removed from her lower leg in 2009 and an angiofibroma removed from her toe in 2011.

Past Medical Hx: bilateral breast cancer, uterine adenocarcinoma, renal cell carcinoma, and multiple meningiomas

Family Hx: No history of cancer or similar skin finding

Allergies: NKA

Physical Exam: Numerous cutaneous facial flesh-colored papules (Fig.1); oral papules with a whitish appearance were present on the tongue and mucosa (Fig.2); lesions on tongue are painful; well-healed scars remained on areas previously biopsied on toe and lower leg.

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