An 11-year-old boy with no significant medical history presents to a pediatric dermatology clinic with a chief complaint of bumps on the penis. These lesions have been present for more than a year but are growing in number. His mother reports 1 previous episode in which the bumps became red and tender, but they are otherwise asymptomatic. She reports that there are no known contacts with warts. He has a history of attention-deficit/hyperactivity disorder for which he takes dextroamphetamine-amphetamine, and he has no known allergies. He is a developmentally appropriate, healthy child entering seventh grade. He has no trouble concentrating and no changes in mood, sleep, appetite, elimination, or self-image. He feels safe at home, and his mother has no concern for sexual abuse or household stressors.

On examination he is a well-appearing child with approximately 15 hyperpigmented tan and flesh-toned, 1- to 2-mm, dome-shaped papules on the shaft and...

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