A 6-month-old African American girl presents for a well-child visit and is found to have multiple yellow-brown, dome-shaped papules over her face, neck, and trunk. The lesions were first noticed at her 4-month visit as three similar 5- to 7-mm papules on her forehead and were diagnosed as congenital nevi. Over the past 2 months, the lesions have increased in size and number and now extend all over her forehead, cheeks, eyelids, ears, neck, and trunk. The infant seems to be unaffected by these lesions. There have been no complaints of increased fussiness, disturbed sleep, itching, or poor feeding.

The patient's perinatal history is unremarkable. The past medical and surgical history is noncontributory. Her only medication is sodium fluoride 0.25 mg daily. She is following her growth curves and has achieved age-appropriate milestones. There have been no similar skin lesions in her parents or grandparents.

On physical examination, the infant...

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