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Pigmented Lesions of the Skin

Author: akanksha, Posted on Wednesday, April 18 @ 16:33:59 IST by akanksha  

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A 6-year-old boy is brought in to clinic by his parents with a deep purple lesion over his right zygoma. It has been present since birth and he is otherwise well. On examination it extends over the entire cheek and is lumpy and thickened on palpation. There is no associated lymphadenopathy. Most probable diagnosis is:

a. Strawberry naevus
b. Deep capillary naevus
c. Lentigo
d. Superficial spreading melanoma

Correct Answer: b – Deep capillary naevus

These are also known as port-wine stains and are formed by capillaries in the upper and deeper dermis. Together with superficial capillary naevi (‘stork marks’), it belongs to the group of vascular naevi.

Most occur on the head and neck and tend to be unilateral, often appearing in the territory of one or more branches of the trigeminal nerve.

They can be extensive and cosmetically disfiguring. At birth they can vary from pink to dark purple, darkening over time. Lumpy angiomatous nodules may also develop within the lesion.

Often these lesions can be lasered with reasonable results. There are some important considerations:

 - associated intracranial vascular malformation resulting in convulsions and delayed development, known as Sturge–Weber syndrome

 - congenital glaucoma if lesion occurs in ophthalmic division of trigeminal nerve

 - hypertrophy of underlying tissues, eg the limb, causing abnormal growth known as haemangiectatic hypertrophy.



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