ANSWER
The correct answer—the false statement—is that SA has no pathologic implications (choice “a”).
DISCUSSION
SAs are usually benign and occur in 10% to 15% of the population (particularly in children). But they can sometimes be a sign of serious disease such as liver failure, with related esophageal varices, especially if > 3 lesions are present.
SAs are caused by a failure in the sphincter muscle surrounding a dilated cutaneous arteriole, which in turn is caused by increased estrogen levels in the blood. This increase can be related to the estrogen in birth control medications or to pregnancy.
A diseased liver, unable to metabolize estrogen properly, can contribute to increased blood levels of estrogen. For example, about one-third of patients with cirrhosis will develop multiple SAs.
SAs are seen only in the distribution of the superior vena cava. This means that—in addition to manifesting on the face—they can also appear on the arms, hands, trunk, and fingers.
Momentarily fading completely when central pressure is applied is a peculiar trait of SAs and is therefore diagnostic.
TREATMENT
While these lesions do, in fact, usually resolve on their own, treatment attempts are usually highly satisfactory. In my experience, destruction by laser ablation is superior to electrodessication, though recurrences are common. At the time of this presentation, the patient and her mother were still pondering the treatment options.