The FP recognized these flat-topped papules as angiokeratomas of the scrotum (also known as Fordyce spots). These are more common in men, but can also occur on the vulva.
Angiokeratomas are dilated superficial blood vessels that may be associated with increased venous pressure. The papules are also associated with hyperkeratosis and may bleed easily with trauma.
Angiokeratomas can be eradicated by cryotherapy, electrodesiccation, or laser. As these are benign vascular lesions, most physicians recommend leaving them alone. If there is a single dark angiokeratoma (which might mimic a melanoma), a biopsy is needed to avoid missing a possible malignancy. In the case of multiple benign appearing angiokeratomas of the scrotum, reassurance is the best management option.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Hitzeman N. Acquired vascular lesions in adults. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:861-864.
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