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Dermatology Discussion

Enlarging Skin Lesion Since Birth

St. Johns Episcopal Hospital, South Shore, Far Rockaway, New York

September 2004

Presenters: Dr. Suzanne Sirota Rozenberg, PGY3, Dr. Norma Montiel, PGY2

Program Director: Marvin Watsky, D.O.

Clinical Presentation

1 month old African-American female

History

Chief Complaint: 1 month old female presents with an enlarging skin lesion since birth of the right forearm, wrist and hand.

Signs and symptoms: The mother states that the lesion has been present since the baby was born and has been getting bigger. The child demonstrates full range of motion of the arm, no crying,crankiness or failure to thrive.

Previous Treatment: none

Other Information: the patient was born premature at 35 weeks and demonstrated no postnatal complications

Physical Examination

On physical, an erythematous and violaceous papule extending from the forearm to the wrist to the hand and thumb was noted. Easy compressability and blanching were present. No ulcerations or active bleeding were noted. Wrist circumference of the right was 10 ½ cm and the left was 10cm. forearm to the wrist 9 cm on the right and 9 ½ cm on the left. Pt was noted to have a sacral dimple and overlying Mongolian spot as well

Laboratory Tests

Ultrasound of the lumbosacral spine was unremarkable.

Head CT was also unremarkable.

Genetic testing showed a normal 46 XX karyotype.

All other tests at birth were normal.

Dermatohistopathology

Microscopic description:

No biopsy was done on this baby.

Differential Diagnosis