Question:

This is a 48-year old man who was admitted for investigation of a palpable liver and spleen. There are many similar skin rashes elsewhere on the body.

Answer: A. Spider naevi

Spider naevi can be easily recognised and confirmed clinically by pressing on the centre of the lesion causing the disappearance of the radiating capillaries. They are more often seen on faces of normal children, pregnant women or those patients with active liver disease. Liver function should be checked in those with numerous spider naevi. It seldom requires treatment except for cosmetic purpose. The central feeding vessel can be destroyed easily by light electrodesiccation with good cosmetic outcome. Today yellow light laser e.g. Copper vapour, Krypton, pulse dye lasers can all easily do the job but they are more costly. Cherry angioma or Campbell de Morgan spot is an acquired angioma. There will not be any radiating telangiectatic vessels from a central vessel. Telangiectasia will be found in rosacea patients but flushing, inflammatory papules, pustules will be the main clinical presentation. Kaposi sarcoma occasionally may be confused with some acquired vascular naevi but it never has such typical radiating legs from a central feeding vessel.