Sunday, June 7, 2015

54 year male - cherry red and 1 mm in diameter,for a few years according to the patient.

A 54-year-old man is in the clinic for an annual visit. 

On physical examination,
he inquires about multiple red entities present on his chest, upper arms, and back, as shown above. The lesions are cherry red and 1 mm in diameter. They have been there for a few years according to the patient.
He has no other health complaints and no significant past medical history.

What is the best next step in workup for this patient?
A. Investigation for a visceral adenocarcinoma
B. Biopsies of the lesions to rule out malignancy
C. Mohs procedure for removal
D. Elective laser removal or electrocoagulation
E. Wide local excision

The answer is D: Elective laser removal or electrocoagulation. This patient has a normal finding
of cherry angiomas, which represent benign vascular lesions that are more common with increasing age. The histology of the lesions consists of dilated capillaries and an edematous stroma with homogenization of collagen. They are extremely common in the elderly and have no clinical significance (A, B). However, lesions that generate cosmetic concern may be treated
with laser therapy or electrocoagulation (D). These findings do not warrant more invasive treatment (C, E).

Cherry hemangiomas (or cherry angiomas) are common, asymptomatic, domed vascular lesions that vary in color from bright red to violaceous or black. They are found typically on the trunk, appearing around age 30 and increasing in numbers with age. They have no clinical significance but may pose a cosmetic concern. If desired, they can be treated with laser removal or electrocoagulation.

■ Often less than 3 mm in diameter; some smaller lesions are only distinguished from petechiae by their permanence.
■ Histology consisting of numerous dilated capillaries lined by flattened endothelium, edematous stroma, and homogenized collagen
■ Numbers increase with age but have no clinical significance.


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