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Asymptomatic labial papules in a teenager.

A 12-year-old Native American girl presented with an 8-month history of asymptomatic growths on the mucosal aspect of her upper and lower lips. She was not sexually active and was otherwise healthy. There was no family history of similar lesions. Physical examination revealed several nontender papules measuring 0.3 to 1.0 cm scattered over the labial mucosa (Figure 1). The rest of the oral mucosa, including the vermilion, buccal mucosa, and tongue, was spared. When stretched, the papules became nearly imperceptible. A shave biopsy specimen was obtained from one of the papules (Figure 2 and Figure 3). What is your diagnosis?