Angiokeratoma in a 65-Year-Old Man

A 65-year-old man had had an asymptomatic lesion on his left lateral lower leg for several weeks. The dark maroon, almost black, 3- to 4-mm, circular, elevated lesion had a convoluted surface of dilated vessels. Robert P. Blereau, MD of Morgan City, La, excised the papule via a punch biopsy; pathologic examination identified an angiokeratoma.

Angiokeratomas are benign; they result from ectasia of the superficial dermal vessels and hyperkeratosis of the overlying dermis. Solitary and less common multiple angiokeratomas may occur anywhere on the body and may arise in a zosteriform distribution.

A number of types of angiokeratomas have been described. The most common variant is the scrotal, or Fordyce, angiokeratoma, which is often seen in elderly men and presents as a 2- to 3-mm red to purple papule. In young women, an equivalent lesion can occur on the vulva secondary to the venous pressure of pregnancy.

Angiokeratomas of Mibelli are warty lesions on the hands, feet, elbows, and knees of children and adolescents, most frequently girls. The least common variant is angiokeratoma circumscriptum, a condition usually characterized by unilateral lesions on the leg, trunk, or arm of female infants or children. Multiple papules in clusters-angiokeratoma corporis diffusum-generally arise in the bathing trunk area and are associated with Anderson-Fabry disease or other enzyme disorders, although some patients have normal enzyme activity.

Usually, angiokeratomas require no treatment. If desired, the lesions may be excised or removed by electrodesiccation and curettage.

FOR MORE INFORMATION:

• Weedon D. Skin Pathology. Edinburgh: Churchill Livingston; 1997:823-824.