A 48-year-old man comes to the physician with a red skin lesion on his abdomen. He first noticed it 6 months ago and says that it has been enlarging recently. The lesion bleeds occasionally when disturbed but is otherwise asymptomatic. The patient has a history of hypertension and actinic keratosis. He has a 25-pack-year smoking history and drinks a 6-pack of beer daily. Physical examination findings are shown in the image below. Which of the following is the most appropriate next step in management of this patient's skin lesion?

Question

A 48-year-old man comes to the physician with a red skin lesion on his abdomen.  He first noticed it 6 months ago and says that it has been enlarging recently.  The lesion bleeds occasionally when disturbed but is otherwise asymptomatic.  The patient has a history of hypertension and actinic keratosis.  He has a 25-pack-year smoking history and drinks a 6-pack of beer daily.  Physical examination findings are shown in the image below.  Which of the following is the most appropriate next step in management of this patient's skin lesion?

Quizplus · Accepted Answer

Explanation: This patient's skin lesion is consistent with a cherry angioma (CA), which is a common benign vascular tumor seen in adults. CA is characterized by sharply circumscribed areas of congested capillaries and post-capillary venules in the papillary dermis. Patients usually develop multiple small, vascular, bright-red, and dome-shaped papules. CAs are most commonly found on the trunk, and occur only in skin and not in deep tissues or mucosa. The lesions usually blanch with pressure, but some lesions can become fibrotic over time and will not blanch. CAs usually do not regress spontaneously and are sometimes called senile hemangiomas as they increase in number as the patient ages. They may occasionally bleed if disturbed but are otherwise asymptomatic and do not need treatment other than for cosmetic reasons. Electrocauterization under local anesthesia can treat small lesions, while shave excision with electrocauterization is required for larger lesions (Choice A). (Choice B) Kaposi sarcoma (KS) is most often seen in patients who have coinfection with HIV and human herpesvirus type 8 (HHV-8); it is considered an AIDS-defining condition. KS usually appears as deep red, purple, or brown macules on the trunk, extremities, and face. The lesions can also present as plaques or nodules that are ovoid and linear in shape along skin tension lines. Kaposi sarcoma (KS) nodules (Choice C) Spider angiomas usually present as bright red central papules surrounded by several outwardly radiating vessels. They occur due to dilated central arterioles and associated superficial capillary networks. Spider angiomas are estrogen dependent and are commonly found in patients with cirrhosis. Spider angiomas (Choice D) Propranolol is a treatment option for infantile (strawberry) hemangiomas. These grow rapidly but spontaneously regress by age 5-8. Most infantile hemangiomas may be managed conservatively, though beta-blockers may occasionally be needed for ulcerating lesions. infantile (strawberry) hemangiomas Educational objective: Cherry angiomas (CAs) usually present as multiple small, vascular, bright-red, and dome-shaped papular lesions in adults. CAs are benign lesions that increase in number with age and do not regress spontaneously. Most lesions do not require treatment.

A 48-Year-Old Man Comes to the Physician with a Red