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Simple cases
Case 34
A 24-year-old lady requests removal of the dark supraclavicular lesion.
History
How long have you had this lesion?
Since I was born.
Such lesions usually are present at birth or appear soon thereafter.
Has it grown recently?
No.
These lesions may grow in infancy, but then many regress. Some remain stable, but none grow in adulthood.
Does it itch?
No.
Most vascular lesions do not itch.
Does it get pale when you press on it?
Yes.
When a lesion is vascular, it will blanch or disappear with pressure. A physician uses a glass slide or spatula to test this, the procedure is known as diascopy.
Do you have any other similar lesions?
Yes, I have three on my back.
The most common sites are the face, neck and trunk.
Did it ever bleed?
No.
If such a lesion is injured, bleeding is likely, but easily stopped with pressure.
Lesion
Choose the right efflorescences:
False. A pustule is a papule filled with pus.
False. An erosion is a superficial skin defect.
False. A rhagade is a tear or fissure.
Correct. This is a circumscribed, soft raised nodule.
Diagnosis
Choose the right diagnosis:
False. A lipoma is a subcutaneous fat tumor. It is palpable, but does not have a red surface.
False. A keloid is one form of excess scar tissue, always appeared a papule or nodule at a site of trauma.
False. Melanocytic nevi are tan or brown macules and papules, not seen here.
False. Melanocytic nevi are tan or brown macules and papules, not seen here.
Therapy
Choose the right therapy(ies):
False. Many hemangiomas regress spontaneously. Treatment may be required for lesions interfering with vital functions (seeing, eating, breathing, defecating), when disseminated intravascular coagulation occurs (Kasabach-Merritt syndrome) or with internal organ involvement.
False. UV light has no effect on hemangiomas.
Dye lasers are effective for the treatment of small superficial hemangiomas.
Correct. Systemic interferon-α is the treatment of choice for large, life-threatening hemangiomas, especially when systemic.
Test
The following questions are related to the current case. Try to solve them.
