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Angiokeratoma of the Scrotum Differential Diagnoses

  • Author: Yoon-Soo (Cindy) Bae, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Apr 09, 2015
 
 

Diagnostic Considerations

Patients with history of genitourinary malignancy and subsequent surgical or radiation therapy may develop angiokeratomas of Fordyce. These lesions may be alarming as potential recurrence[17] or metastatic presentation of the cancer. Performing a biopsy and reassuring patients of the benign nature of these lesions is important.

The most ominous clinical differential diagnostic consideration is malignant melanoma. Angiokeratomas are composed of superficial vessels immediately subjacent to the epidermis, and because of the common occurrence of intraepidermal hemorrhage and subepidermal thrombosis, the lesions appear deeply pigmented or black from a clinical standpoint, and thus simulate the clinical appearance of melanoma. If the diagnosis is in doubt, then the patient should be referred to a dermatologist to examine the lesion and to perform a biopsy, if needed. Epiluminescent examination (dermoscopy examination) also can be useful in the distinction of a vascular from a melanocytic neoplasm.

Fordyce angiokeratomas also must be distinguished from angiokeratomas of Fabry disease. Patients with Fabry disease may report lancinating limb pain or a history of renal disease. Routine histology sometimes demonstrates vacuoles within endothelial cells in patients with Fabry disease. Electron microscopy may demonstrate lamellated inclusion bodies within endothelial cells. Fabry disease should be considered when angiokeratomas are present on the shaft, sacrum, or suprapubic areas in addition to the scrotum.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Yoon-Soo (Cindy) Bae, MD Clinical Assistant Professor, Ronald O Perelman Department of Dermatology, New York University School of Medicine; Procedural Dermatologist, Laser and Skin Surgery Center of New York

Yoon-Soo (Cindy) Bae, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Massachusetts Medical Society, Women's Dermatologic Society, New England Dermatological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Marianna Blyumin-Karasik, MD Dermatologist, Minars Dermatology; Consulting Dermatologist, Memorial Regional Hospital; Voluntary Instructor in Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami, Leonard M Miller School of Medicine

Marianna Blyumin-Karasik, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, Women's Dermatologic Society, Dermatology Foundation

Disclosure: Nothing to disclose.

Meredith M Hancock, MD Resident Physician, Department of Dermatology, Marshfield Clinic/Saint Joseph’s Hospital

Meredith M Hancock, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Society for Pediatric Dermatology, Women's Dermatologic Society, National Psoriasis Foundation, Medical Dermatology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Timothy McCalmont, MD Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

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, United States and Canadian Academy of Pathology

Disclosure: Received consulting fee from Apsara for independent contractor.

Acknowledgements

Vincent A De Leo, MD Clinical Professor of Dermatology, Department of Dermatology, College of Physicians and Surgeons of Columbia University; Chairman, Department of Dermatology, Director of Dermatology Residency Training Program, St Luke's-Roosevelt Hospital Center; Chairman, Department of Dermatology, Beth Israel Medical Center

Vincent A De Leo, MD is a member of the following medical societies: American Academy of Dermatology, American College of Occupational and Environmental Medicine, American Contact Dermatitis Society, American Dermatological Association, American Medical Association, American Society for Photobiology, Dermatology Foundation, New York Academy of Medicine, New York County Medical Society, Photomedicine Society, Society for Investigative Dermatology,Society of Toxicology, and Women's Dermatologic Society

Disclosure: estee lauder Consulting fee Consulting; laroche posay Consulting fee Consulting; schering plough Consulting fee Consulting; pfizer Consulting fee Consulting; orfagen Grant/research funds study – clinical

Amor Khachemoune, MD, CWS Mohs Micrographic Surgery, Dermatopathology, 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.

Joseph J Shaffer, MBBS Fellow, Dermatologic Surgery, Department of Cutaneous Surgery, Fairview University Medical Center

Joseph J Shaffer is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Image courtesy of Hon Pak, MD, and reviewed by Ross Levy, MD.
Close-up of the eruption. Image courtesy of Hon Pak, MD, and reviewed by Ross Levy, MD.
 
 
 
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