A 15-year-old boy presented with multiple, widespread blue skin lumps. The lesions were first noted when he was 6 years of age, and had gradually increased in size. The lesions were characteristically tender on deep palpation, and there was no history of bleeding. The patient's 21-year-old brother had a similar lesion on his chest.On examination, partially compressible dermal and subcutaneous bluish nodules, 5-15 mm in diameter, were seen on the dorsum of the left hand, on the left palm and extensor surface of the right forearm, and overlying the right scapula (Fig. 1). A nodular lesion on the right forearm was excised for histology.