TELEDERMATOLOGY READER REPORT1

History

Chief complaint

Presenting for diagnosis of a lesion.

History of present illness

A 54-year-old lady presents with "bleeding purple spots" located on her vulvar area. She believes the number is increasing. They have been present for a duration of 3 years (Figure 1). Prior treatment: none. Her primary symptom: bleeding. Denies any history of trauma or surgery. Prior biopsy: none. She has no personal or family history of skin cancer or melanoma. Other significant laboratory/study findings: none.

Image Quality Assessment

Fully satisfactory.

TELEDERMATOLOGY IMAGING READER REPORT

One image was provided that shows multiple, 2- to 4-mm, discrete, dome-shaped, violaceous papules involving the external labia majora. One with a bloody crust. Minimal scale.

INTERPRETATION OF IMAGES

Lesion A

Findings

The presented lesions and history are most consistent with the diagnosis of angiokeratomas.

RECOMMENDATIONS

Skin Care and Treatment Recommendations

We recommend reassurance of the benign nature of these lesions to the patient. Per patient preference, if treatment is requested, light electrocautery/coagulation or 578-nm copper, argon, or Nd:Yag laser can be performed to the lesions.

RECOMMENDED FOLLOW-UP

Type of Visit

Return to primary provider for reassurance and to discuss whether the patient would like to pursue treatment.

CLINICAL PEARL

Angiokeratomas are superficial, ectatic blood vessels, which give them the intense red, blue, or violaceous hue (Bolognia, Jorizzo, & Schaffer, 2012; Bae, 2015). There are localized and systemic forms, with localized forms being more common. Within the localized forms, the Fordyce type involves one to multiple angiokeratomas of the vulva or scrotum. Vulvar angiokeratomas are associated with increased venous pressure in pregnancy, varicosities, and oral contraceptive use.

As they are benign, the provider can provide reassurance that they do not require treatment unless symptomatic or cosmetically distressing. The most common symptom is bleeding. This may occur after scratching or intercourse or spontaneously. Patients often do not notice the lesions until an episode of bleeding. Destruction of the lesions may require multiple sessions and does not prevent the development of future lesions.

References