eMedicine Specialties > Dermatology > Benign Neoplasms

Angiokeratoma of the Scrotum: Differential Diagnoses & Workup

Author: Amor Khachemoune, MD, CWS, Clinical Instructor, Mohs Micrographic Surgery, Department of Dermatology, State University of New York Downstate Medical Center; Consulting Staff, Department of Dermatology, Veterans Affairs Medical Center of Brooklyn
Coauthor(s): Yoon-Soo Bae-Harboe, MD, General Surgery Intern, New York-Presbyterian Hospital of Weill Cornell Medical College; Marianna Larisa Blyumin, MD, Staff Physician, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine
Contributor Information and Disclosures

Updated: Sep 25, 2009

Differential Diagnoses

Angiokeratoma Corporis Diffusum (Fabry Syndrome)
Nevi, Melanocytic
Cherry Hemangioma
Petechial angioma
Granuloma pyogenicum
Squamous cell carcinoma of the penis
Malignant Melanoma
Warts, Genital

Other Problems to Be Considered

Patients with history of genitourinary malignancy and subsequent surgical or radiation therapy may develop angiokeratomas of Fordyce. These lesions may be alarming as potential recurrence16 or metastatic presentation of the cancer. Performing a biopsy and reassuring patients of the benign nature of these lesions is important.

Workup

Imaging Studies

  • Imaging studies are not warranted in the evaluation of angiokeratomas.

Procedures

  • Dermoscopy can assist with the diagnosis. Angiokeratoma is characterized by large, well-demarcated, round-to-oval, and red-to-black areas, which are lacunar. In addition, a white surrounding veil corresponds to the acanthotic and hyperkeratotic epidermis.15
  • If the diagnosis is in doubt, then a skin biopsy is recommended.

Histologic Findings

Numerous dilated, thin-walled vessels are positioned in the papillary dermis or superficial submucosa, with an intimate relationship to the overlying acanthotic epidermis with overlying parakeratosis.16 In addition to elongation of the rete ridges, the epithelium is usually hyperkeratotic. Thrombosis of the vascular spaces is common, and, frequently, recanalization of occluded vascular spaces occurs, creating the pathologic pattern known as papillary endothelial hyperplasia (Masson lesion).15

More on Angiokeratoma of the Scrotum

Overview: Angiokeratoma of the Scrotum
Differential Diagnoses & Workup: Angiokeratoma of the Scrotum
Treatment & Medication: Angiokeratoma of the Scrotum
Follow-up: Angiokeratoma of the Scrotum
Multimedia: Angiokeratoma of the Scrotum
References
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References

  1. Fordyce JA. Angiokeratoma of the scrotum. J Cutan Genitourin Dis. 1896;14:81-7.

  2. Schiller PI, Itin PH. Angiokeratomas: an update. Dermatology. 1996;193(4):275-82. [Medline].

  3. Carrasco L, Izquierdo MJ, Farina MC, Martín L, Moreno C, Requena L. Strawberry glans penis: a rare manifestation of angiokeratomas involving the glans penis. Br J Dermatol. Jun 2000;142(6):1256-7. [Medline].

  4. Gioglio L, Porta C, Moroni M, Nastasi G, Gangarossa I. Scrotal angiokeratoma (Fordyce): histopathological and ultrastructural findings. Histol Histopathol. Jan 1992;7(1):47-55. [Medline].

  5. Imperial R, Helwig EB. Angiokeratoma of the vulva. Obstet Gynecol. Mar 1967;29(3):307-12. [Medline].

  6. Agger P, Osmundsen PE. Angiokeratoma of the scrotum (Fordyce). A case report on response to surgical treatment of varicocele. Acta Derm Venereol. 1970;50(3):221-4. [Medline].

  7. Yamazaki M, Hiruma M, Irie H, Ishibashi A. Angiokeratoma of the clitoris: a subtype of angiokeratoma vulvae. J Dermatol. Sep 1992;19(9):553-5. [Medline].

  8. Jansen T, Bechara FG, Stucker M, Altmeyer P. Angiokeratoma of the scrotum (Fordyce type) associated with angiokeratoma of the oral cavity. Acta Derm Venereol. 2002;82(3):208-10. [Medline].

  9. Muller C, James WD. Angiokeratoma of Fordyce as a cause of red scrotum. Cutis. 2002;69:50–51.

  10. Erkek E, Basar MM, Bagci Y, Karaduman A, Bilen CY, Gokoz A. Fordyce angiokeratomas as clues to local venous hypertension. Arch Dermatol. Oct 2005;141(10):1325-6. [Medline].

  11. McNeely TB. Angiokeratoma of the clitoris. Arch Pathol Lab Med. Aug 1992;116(8):880-1. [Medline].

  12. Imperial R, Helwig EB. Angiokeratoma of the scrotum (Fordyce type). J Urol. Sep 1967;98(3):379-87. [Medline].

  13. Orvieto R, Alcalay J, Leibovitz I, Nehama H. Lack of association between varicocele and angiokeratoma of the scrotum (Fordyce). Mil Med. Jul 1994;159(7):523-4. [Medline].

  14. Izaki M. Angiokeratoma of the Scrotum (Fordyce). Keio J Med. 1952;1:61-8.

  15. Leis-Dosil VM, Alijo-Serrano F, Aviles-Izquierdo JA, Lazaro-Ochaita P, Lecona-Echeverria M. Angiokeratoma of the glans penis: clinical, histopathological and dermoscopic correlation. Dermatol Online J. May 1 2007;13(2):19. [Medline].

  16. Pianezza ML, Singh D, Van der Kwast T, Jarvi K. Rare case of recurrent angiokeratoma of Fordyce on penile shaft. Urology. 2006/10;68(4):891.e1-3.

  17. Malalasekera AP, Goddard JC, Terry TR. Angiokeratoma of Fordyce simulating recurrent penile cancer. Urology. Mar 2007;69(3):576.e13-4. [Medline].

  18. Yigiter M, Arda IS, Tosun E, Celik M, Hiçsönmez A. Angiokeratoma of clitoris: a rare lesion in an adolescent girl. Urology. Apr 2008;71(4):604-6. [Medline].

  19. Baruah J, Roy KK, Rahman SM, Kumar S, Pushparaj M, Mirdha AR. Angiokeratoma of vulva with coexisting human papilloma virus infection: a case report. Arch Gynecol Obstet. Aug 2008;278(2):165-7. [Medline].

  20. Al-Mutairi N, Joshi A, Nour-Eldin O. Naevus lipomatosus cutaneous superficialis of Hoffmann-Zurhelle with angiokeratoma of Fordyce. Acta Derm Venereol. 2006;86(1):92-3. [Medline].

  21. Karthikeyan K, Sethuraman G, Thappa DM. Angiokeratoma of the oral cavity and scrotum. J Dermatol. Feb 2000;27(2):131-2. [Medline].

  22. Caputo R, Passoni E, Cavicchini S. Papular xanthoma associated with angiokeratoma of Fordyce: considerations on the nosography of this rare non-Langerhans cell histiocytoxanthomatosis. Dermatology. 2003;206(2):165-8. [Medline].

  23. Pavone P, Lucenti C, Fraggetta F, Micali G, Incorpora G, Ruggieri M. Congenital lymphedema-lymphangiectasia associated with scrotal angiokeratoma (Fordyce Type) and hearing impairment. J Clin Gastroenterol. Jul 2008;42(6):715-9. [Medline].

  24. Hisa T, Taniguchi S, Goto Y, et al. Scrotal angiokeratoma in a young man. Acta Derm Venereol. May 1996;76(3):248-9. [Medline].

  25. Blair C. Angiokeratoma of the vulva. Br J Dermatol. Sep 1970;83(3):409-11. [Medline].

  26. Patrizi A, Neri I, Trevisi P, Landi C, Bardazzi F. Congenital angiokeratoma of Fordyce. J Eur Acad Dermatol Venereol. Mar 1998;10(2):195-6. [Medline].

  27. Bechara FG, Jansen T, Wilmert M, Altmeyer P, Hoffmann K. Angiokeratoma Fordyce of the glans penis: combined treatment with erbium: YAG and 532 nm KTP (frequency doubled neodynium: YAG) laser. J Dermatol. Nov 2004;31(11):943-5. [Medline].

  28. Taniguchi S, Inoue A, Hamada T. Angiokeratoma of Fordyce: a cause of scrotal bleeding. Br J Urol. May 1994;73(5):589-90. [Medline].

  29. Atherton DJ, and Moss C. Breathnach S, Cox N, et al (Eds). Naevi and other developmental defects, in Burns T : Rook's Textbook of Dermatology. Oxford: Blackwell Science; 2004:pp 15.87–15.90.

  30. Panotte DM. Angiokeratoma: a cause of scrotal bleeding. South Med J. 1985;78:487-488.

  31. Lapins J, Emtestam L, Marcusson JA. Angiokeratomas in Fabry's disease and Fordyce's disease: successful treatment with copper vapour laser. Acta Dermatol Venereol. 1993;73:133–5.

  32. Occella C, Bleidl D, Rampini P, Schiazza L, Rampini E. Argon laser treatment of cutaneous multiple angiokeratomas. Dermatol Surg. Feb 1995;21(2):170-2. [Medline].

  33. Lapidoth M, Ad-El D, David M, Azaria R. Treatment of angiokeratoma of Fordyce with pulsed dye laser. Dermatol Surg. Sep 2006;32(9):1147-50. [Medline].

  34. Ozdemir M, Baysal I, Engin B, Ozdemir S. Treatment of angiokeratoma of Fordyce with long-pulse neodymium-doped yttrium aluminium garnet laser. Dermatol Surg. Jan 2009;35(1):92-7. [Medline].

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Further Reading

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Keywords

angiokeratoma of the scrotum, angiokeratoma of Fordyce, Fordyce angiokeratoma, vulvar angiokeratoma

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Contributor Information and Disclosures

Author

Amor Khachemoune, MD, CWS, Clinical Instructor, Mohs Micrographic Surgery, Department of Dermatology, State University of New York Downstate Medical Center; Consulting Staff, Department of Dermatology, Veterans Affairs Medical Center of Brooklyn
Amor Khachemoune, MD, CWS is a member of the following medical societies: American Academy of Dermatology, American Academy of Wound Management, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Yoon-Soo Bae-Harboe, MD, General Surgery Intern, New York-Presbyterian Hospital of Weill Cornell Medical College
Yoon-Soo Bae-Harboe, MD is a member of the following medical societies: American Medical Student Association/Foundation
Disclosure: Nothing to disclose.

Marianna Larisa Blyumin, MD, Staff Physician, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine
Marianna Larisa Blyumin, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Medical Women's Association, American Society for Dermatologic Surgery, Dermatology Foundation, Medical Dermatology Society, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Medical Editor

Timothy McCalmont, MD, Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco
Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Apsara Consulting fee Independent contractor

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Edward F Chan, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine
Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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