History: This 29-year old male presented with asymptomatic umbilicated, well defined papules along the palmar creases and soles which started insidiously and progressed over many years. Sections show a biopsy of skin in which the hyperkeratotic epidermis shows shallow invagination with attenuated granular layer, which is intact at the periphery. Parakeratosis and scattered dyskeratotic keratinocytes are also evident.