A 13-year-old male presented with new onset swelling of the right lower extremity near his ankle (Figure 1). A mass was noted months earlier, but at time of presentation the lesion had increased in size causing daily pain, limiting use of the extremity. No other skin lesions were noted and the child was otherwise healthy. On physical exam, a 6 cm x 6 cm soft, tender, palpable mass was present within the subcutaneous tissue of the ankle near the lateral malleolus. The overlying tissue demonstrated a slight bluish hue. No hardened nodules were palpated. Differential diagnosis included fatty tumors such lipoblastoma, inflammatory process (abscess, subcutaneous granuloma annulare), sarcoma, or vascular anomaly.