A 55-year-old man comes to the physician with red skin lesions on his abdomen. The patient reports no associated symptoms but says his wife is concerned about possible malignancy. He has hypertension and degenerative joint disease but no other medical problems. Physical examination shows the findings in the image below: Which of the following is the most likely diagnosis in this patient?

Question

A 55-year-old man comes to the physician with red skin lesions on his abdomen.  The patient reports no associated symptoms but says his wife is concerned about possible malignancy.  He has hypertension and degenerative joint disease but no other medical problems.  Physical examination shows the findings in the image below:  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

The small, vascular, bright-red papular lesions shown in the image are cherry angiomas (CA). CAs, also known as senile hemangiomas, are the most common benign vascular tumors in adults. They are typically first seen in the 3rd or 4th decade of life, and their number increases with age. They appear as sharply circumscribed areas of congested capillaries and postcapillary venules in the papillary dermis. CAs are always cutaneous and are not found on mucosa or deep tissues. They do not regress spontaneously and may bleed if disturbed, but they are benign and do not require treatment for any other than cosmetic reasons. (Choice A) Basal cell carcinoma (BCC) is a common skin malignancy of low metastatic potential. It typically appears as an enlarging fleshy nodule with ulceration. BCC is associated with sun exposure and is most common on the face, neck, and extremities. Basal cell carcinoma (BCC) (Choice B) Cavernous hemangiomas, also known as cavernous malformations, consist of dilated vascular spaces with thin-walled endothelial cells. They present as soft blue, compressible masses growing up to a few centimeters. Cavernous hemangiomas may appear on the skin, mucosa, deep tissues, and viscera. Cavernous hemangiomas of the brain and viscera are associated with von Hippel-Lindau disease. Cavernous hemangiomas (Choice D) Kaposi sarcoma is characterized by reddish purple, dark vascular plaques or nodules on cutaneous or mucosal surfaces. It is associated with human herpesvirus 8 and is frequently seen in patients with concurrent HIV infection. Kaposi sarcoma (Choice E) Spider angiomas consist of bright-red central arterioles surrounded by several outwardly radiating vessels. They blanch with pressure. They are estrogen dependent and are commonly seen in pregnancy, oral contraceptive use, and cirrhosis-related hyperestrogenemia. Spider angiomas (Choice F) Strawberry (infantile) hemangiomas appear during the first weeks of life. They initially grow rapidly and then frequently regress spontaneously by age 5-8. They are bright red when near the epidermis and more violaceous when deeper. Strawberry (infantile) hemangiomas Educational objective: Cherry hemangiomas are small, red, cutaneous papules common in aging adults. They do not regress spontaneously, but they are benign and generally do not require treatment.

A 55-Year-Old Man Comes to the Physician with Red Skin