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ANSWER
The correct answer—the false statement—is that SA has no pathologic implications (choice “a”).
DISCUSSION
SAs are usually benign and occur in 10% to 15% of the population (particularly in children). But they can sometimes be a sign of serious disease such as liver failure, with related esophageal varices, especially if > 3 lesions are present.
SAs are caused by a failure in the sphincter muscle surrounding a dilated cutaneous arteriole, which in turn is caused by increased estrogen levels in the blood. This increase can be related to the estrogen in birth control medications or to pregnancy.
A diseased liver, unable to metabolize estrogen properly, can contribute to increased blood levels of estrogen. For example, about one-third of patients with cirrhosis will develop multiple SAs.
SAs are seen only in the distribution of the superior vena cava. This means that—in addition to manifesting on the face—they can also appear on the arms, hands, trunk, and fingers.
Momentarily fading completely when central pressure is applied is a peculiar trait of SAs and is therefore diagnostic.
TREATMENT
While these lesions do, in fact, usually resolve on their own, treatment attempts are usually highly satisfactory. In my experience, destruction by laser ablation is superior to electrodessication, though recurrences are common. At the time of this presentation, the patient and her mother were still pondering the treatment options.
ANSWER
The correct answer—the false statement—is that SA has no pathologic implications (choice “a”).
DISCUSSION
SAs are usually benign and occur in 10% to 15% of the population (particularly in children). But they can sometimes be a sign of serious disease such as liver failure, with related esophageal varices, especially if > 3 lesions are present.
SAs are caused by a failure in the sphincter muscle surrounding a dilated cutaneous arteriole, which in turn is caused by increased estrogen levels in the blood. This increase can be related to the estrogen in birth control medications or to pregnancy.
A diseased liver, unable to metabolize estrogen properly, can contribute to increased blood levels of estrogen. For example, about one-third of patients with cirrhosis will develop multiple SAs.
SAs are seen only in the distribution of the superior vena cava. This means that—in addition to manifesting on the face—they can also appear on the arms, hands, trunk, and fingers.
Momentarily fading completely when central pressure is applied is a peculiar trait of SAs and is therefore diagnostic.
TREATMENT
While these lesions do, in fact, usually resolve on their own, treatment attempts are usually highly satisfactory. In my experience, destruction by laser ablation is superior to electrodessication, though recurrences are common. At the time of this presentation, the patient and her mother were still pondering the treatment options.
ANSWER
The correct answer—the false statement—is that SA has no pathologic implications (choice “a”).
DISCUSSION
SAs are usually benign and occur in 10% to 15% of the population (particularly in children). But they can sometimes be a sign of serious disease such as liver failure, with related esophageal varices, especially if > 3 lesions are present.
SAs are caused by a failure in the sphincter muscle surrounding a dilated cutaneous arteriole, which in turn is caused by increased estrogen levels in the blood. This increase can be related to the estrogen in birth control medications or to pregnancy.
A diseased liver, unable to metabolize estrogen properly, can contribute to increased blood levels of estrogen. For example, about one-third of patients with cirrhosis will develop multiple SAs.
SAs are seen only in the distribution of the superior vena cava. This means that—in addition to manifesting on the face—they can also appear on the arms, hands, trunk, and fingers.
Momentarily fading completely when central pressure is applied is a peculiar trait of SAs and is therefore diagnostic.
TREATMENT
While these lesions do, in fact, usually resolve on their own, treatment attempts are usually highly satisfactory. In my experience, destruction by laser ablation is superior to electrodessication, though recurrences are common. At the time of this presentation, the patient and her mother were still pondering the treatment options.
About 3 years ago, an asymptomatic lesion appeared on an 8-year-old girl’s right cheek. Because the spot made her feel self-conscious, the child’s mother had tried covering it up with makeup—but the makeup was even more obvious than the spot.
Their primary care provider (PCP) advised them to do nothing, noting that such lesions usually resolve on their own. The PCP did not believe the lesion was indicative of any related health problems. Dissatisfied with this instruction, the mother brings her daughter to dermatology for evaluation.
The girl is in otherwise good health. The lesion in question is a curious, bright red macule consisting of a tiny pinpoint red dot with very narrow “legs” (tiny, slender, red, vascular lines) emanating from the periphery. It is about 7 mm, and the center red dot is about 1 mm in diameter.
Using a dull pencil to create gentle pinpoint pressure causes the whole lesion to instantly and completely fade, only to return fully after pressure is released. The lesion is diagnosed as a typical spider angioma (SA; also known as spider nevi).
