In the store-and-forward teledermatology modality, there is a transfer of patient medical information electronically (including history and visual data) obtained in one location to a provider who is in another location (Roman & Jacob, 2015). The construct of the TeleDermViewPoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report.
TELEDERMATOLOGY READER REPORT1
Chief complaint: Purple painless papule on the trunk. The patient was concerned because it became darker.
History of Present Illness
A 70-year-old man with no personal history of skin cancer or family history of skin cancer presented with a growth on the torso, which recently darkened. Prior treatment: none. His primary symptoms: none. Prior biopsy: none.
IMAGE QUALITY ASSESSMENT
Fully satisfactory.
TELEDERMATOLOGY IMAGING READER REPORT
There are two clinical images provided with this consult (see Figures 1 and 2).
INTERPRETATION OF IMAGES
Lesion A
Findings
The clinical morphology of the lesion, distribution, and history are characteristic for thrombosed hemangioma. The dermoscopy image shows the classic red-clod (lobular lagoon) pattern.
RECOMMENDATIONS
Reassurance of benign nature of the lesion. Reconsult teledermatology for new or changing skin lesions or conditions.
CLINICAL PEARL
Cherry angiomas are the most common of the acquired cutaneous vascular proliferations (Bolognia, Jorizzo, & Schaffer, 2018). Men and women are affected equally, and the lesions usually first appear during the third decade of life or later. Clinically, cherry angiomas appear as round to oval, bright red, dome-shaped papules ranging in size from barely visible to several millimeters in diameter, with the most common location being on the trunk and extremities. They are generally asymptomatic. That said, they may occasionally bleed when traumatized. In the event that trauma leads to clot formation within the lesion, they are referred to as thrombosed hemangiomas. The clinical differential diagnosis includes Kaposi sarcoma or melanoma. Dermoscopy is of high utility in the diagnosis of these lesions, which show the characteristic red-blue lagoons. The thrombosed blood can be visualized and discerned to not be black pigment (Moscarella et al., 2012).
NURSING PERSPECTIVE
Cherry angiomas are benign; however, when traumatized or thrombosed, they may suddenly appear dark and raise the suspicion of a malignant tumor. On dermoscopy evaluation, the lesions will show no pigment network.
REFERENCES