How to diagnose angiokeratoma
The clinical presentation typically suffices in making the diagnosis of an angiokeratoma. If dermoscopy is performed, the characteristic findings include the presence of scale and purple lacunae13 (FIGURE 2). However, when there is suspicion of melanoma or the clinical diagnosis is in doubt, the entire lesion should be removed (with narrow margins) in order to obtain a definitive diagnosis. Histological findings consist of dilated subepidermal vessels associated with epidermal hyperkeratosis.3
FIGURE 2
A view from the dermatoscope
No need to treat, unless there are cosmetic concerns
If the diagnosis is straightforward and a biopsy is not needed, no treatment is necessary because simple angiokeratomas are benign entities. However, treatment may be considered for cosmetic purposes, or to prevent bothersome bleeding. Angiokeratomas may be removed via shave or standard excision, electrodessication and curettage, or destroyed with a laser. For Fabry’s disease, in which numerous angiokeratomas pose a cosmetic concern, laser therapy, including the use of an argon, copper, Nd:Yag, KTP 532-nm, or Candela V-beam laser, is preferred.14
In our patient’s case, we performed a 2-mm punch biopsy, which revealed that the lesion was an angiokeratoma. It was subsequently removed by shave biopsy with clear margins.
CORRESPONDENCE
Thomas M. Beachkofsky, MD, Capt, USAF, MC, Department of the Air Force, Wilford Hall Medical Center, 59 MDW/SG05D/ Dermatology, 2200 Bergquist Drive, Suite 1, Lackland AFB, TX 78236-9908; tbeachkofsky@yahoo.com