A 35-year-old man comes to the office for evaluation of red skin lesions under his nipple that were first noticed by his wife. The lesions are not itchy or painful, and no other family members have skin lesions. He has not used any new soaps, lotions, or detergents. The patient has no known medical problems and takes no medications. He drinks 4-6 beers every night. He does not use tobacco or illicit drugs. Body mass index is 32kg/m2, and vital signs are normal. The skin findings are shown below. Which of the following is the most likely diagnosis in this patient?

Question

A 35-year-old man comes to the office for evaluation of red skin lesions under his nipple that were first noticed by his wife.  The lesions are not itchy or painful, and no other family members have skin lesions.  He has not used any new soaps, lotions, or detergents.  The patient has no known medical problems and takes no medications.  He drinks 4-6 beers every night.  He does not use tobacco or illicit drugs.  Body mass index is 32kg/m2, and vital signs are normal.  The skin findings are shown below.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

This patient's small, bright-red, papular lesions are cherry hemangiomas, also known as cherry angiomas or senile hemangiomas. They are the most common benign vascular tumors in adults and typically appear during the third or fourth decade of life. The lesions do not regress spontaneously and often multiply with age. Cherry hemangiomas are always superficial on the skin and are not found on the mucosa or deep tissues. Histologically, they appear as sharply circumscribed areas of congested capillaries and post-capillary venules in the papillary dermis. (Choice A) Acrochordons (skin tags) are pedunculated outgrowths of normal skin. They are typically seen in areas of friction (eg, neck, axilla, inframammary, groin) of patients with obesity and diabetes mellitus. (Choice B) Cavernous hemangiomas consist of dilated vascular spaces with thin-walled endothelial cells. They present as soft blue, compressible masses up to a few centimeters in size. They may appear on the skin, mucosa, deep tissues, and viscera. When cavernous hemangiomas appear on the skin, they are most frequently based in the dermis. (Choice D) Cystic hygromas are comprised of lymphatic cysts lined by a thin endothelium. These benign tumors are often present at birth and are most commonly located on the posterior neck and lateral chest wall. Cystic hygromas are frequently found in neonates with Turner syndrome and Down syndrome. (Choice E) Spider angiomas consist of a bright red central papule surrounded by several outwardly radiating vessels that blanch with pressure and refill centrifugally upon release. They are associated with increased estrogen states (eg, pregnancy, cirrhosis, oral contraceptive use, estrogen supplement use). (Choice F) Strawberry (also known as infantile or capillary) hemangiomas appear during the first weeks of life. They initially grow rapidly and then frequently regress spontaneously by late childhood. They are bright red when near the epidermis and more violaceous when deeper. Educational objective: Cherry hemangiomas are small, red, cutaneous papules common in aging adults. They do not regress spontaneously and typically increase in number with age. Light microscopy of these lesions shows proliferation of capillaries and post-capillary venules in the papillary dermis. __________ References: Diagnosis and management of infantile hemangiomas. (http://www.ncbi.nlm.nih.gov/pubmed/24636652)

A 35-Year-Old Man Comes to the Office for Evaluation of Red