A 49-year-old woman presents to dermatology with a lesion on her back. It’s been there for at least 20 years, slowly growing to its present size; it is now so prominent that it shows through her clothes and is subject to traumatization. The visibility of the lesion, particularly when the patient wears a swimsuit, is a source of considerable embarrassment.
Notable medical history includes polycystic ovarian syndrome and related diabetes and dyslipidemia. Family history reveals that the patient’s mother died of heart disease in her 40s.
EXAMINATION
The lesion, which measures 3 cm x 3 cm, is an impressive, pedunculated, doughy, rubbery, skin-colored mass protruding from her left mid back. No redness or edema is seen on or around the lesion. On palpation, the lesion is found to be uniformly soft and rubbery.
The patient is quite obese and has numerous skin tags in skin folds, under the arms, and around the neck.
What is the diagnosis?