An 8-year-old, Caucasian boy presented to the pediatric dermatology clinic for evaluation of a skin lesion on the dorsum of his left foot. His parents first noticed the lesion between 12 and 18 months prior and initially attributed it to an ant bite. However, over a period of several months, the lesion experienced rapid growth before finally stabilizing. Associated symptoms included occasional pruritus as well as tenderness with friction from shoes. The parents denied any history of bleeding. Physical examination revealed a 12-mm, smooth, pink plaque with central nodularity and focal border irregularity on the dorsum of the left foot (Figure 1). The patient was referred to orthopedic surgery for excisional biopsy, which was performed under general anesthesia.Histologic sections revealed a dermal-based melanocytic proliferation (Figure 2). Fascicular nests of melanocytes with abundant eosinophilic cytoplasm and distinct nucleoli were seen coursing through a moderately sclerotic dermis (Figure 3). The melanocytes matured with progressive descent into the dermis, becoming smaller and forming smaller nests. Perineural extension was present (Figure 4), with a slight increase in vascularity noted around the periphery of the lesion. An asymmetric, inflammatory infiltrate composed mostly of lymphocytes was evenly distributed throughout the superficial dermis of the lesional tissue (Figure 2). No mitoses were seen.