Nevus Araneus (Spider Nevus) Workup

  • Author: Ronald P Rapini, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Oct 20, 2010
 

Laboratory Studies

Evaluate patients with extensive spider angioma (nevus araneus) lesions for underlying liver disease or for pregnancy, depending on clinical context.

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Other Tests

Confirm the diagnosis of spider angioma (nevus araneus) by observing the classic refill pattern from the central vessel outwards. This refill pattern is seen following compression and release of the lesion. Usually, no other testing is required.

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Procedures

In the rare cases when the diagnosis of spider angioma (nevus araneus) is questionable, consider skin biopsy to exclude basal cell carcinoma or other conditions, particularly if the lesion is enlarging.

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Histologic Findings

The 5 basic components of the spider angioma (nevus araneus) are (1) an arterial net, (2) a central arteriole, (3) a thin-walled ampulla, (4) efferent spider vessels, and (5) capillaries.[1]

The central ascending arteriole ends in a thin-walled ampulla just below the epidermis. This ampulla feeds small arterial branches that radiate in an outward fashion into the superficial dermis. Glomus cells have been reported in the wall of the central arteriole.[1]

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Contributor Information and Disclosures
Author

Ronald P Rapini, MD  Josey Professor and Chair, Department of Dermatology, Professor of Pathology, University of Texas Medical School at Houston and MD Anderson Cancer Center

Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Society for Investigative Dermatology, and Texas Medical Association

Disclosure: Elsevier publishers Royalty Independent contractor

Coauthor(s)

Sarah A Sweeney  University of Texas Medical School at Houston

Sarah A Sweeney is a member of the following medical societies: Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Carrie L Kovarik, MD  Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

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.

References

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  2. Finn SM, Rowland M, Lawlor F, Kinsella W, Chan L, Byrne O, et al. The significance of cutaneous spider naevi in children. Arch Dis Child. Jul 2006;91(7):604-5. [Medline]. [Full Text].

  3. Requena L, Sangueza OP. Cutaneous vascular anomalies. Part I. Hamartomas, malformations, and dilation of preexisting vessels. J Am Acad Dermatol. Oct 1997;37(4):523-49; quiz 549-52. [Medline]. [Full Text].

  4. Graham-Brown RA. Hepatobiliary System and the Skin. In: Irwin Freedberg AE, Klaus Wolff, K Frank Austen, Lowell Goldsmith, Stephen Katz, Thomas Fitzpatric. Fitzpatrick's Dermatology In General Medicine. Fifth. New York: McGraw-Hill; 1999:1918.

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  8. Niederau C, Lange S, Frühauf M, Thiel A. Cutaneous signs of liver disease: value for prognosis of severe fibrosis and cirrhosis. Liver Int. May 2008;28(5):659-66. [Medline]. [Full Text].

  9. Salem A, Gamil H, Hamed M, Galal S. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol. Jun 2010;24(6):649-54. [Medline]. [Full Text].

  10. Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, et al. Role of substance P in the pathogenesis of spider angiomas in patients with nonalcoholic liver cirrhosis. Am J Gastroenterol. Feb 1999;94(2):502-7. [Medline]. [Full Text].

  11. Isner JM, Pieczek A, Schainfeld R, Blair R, Haley L, Asahara T, et al. Clinical evidence of angiogenesis after arterial gene transfer of phVEGF165 in patient with ischaemic limb. Lancet. Aug 10 1996;348(9024):370-4. [Medline]. [Full Text].

  12. Li CP, Lee FY, Hwang SJ, Lu RH, Lee WP, Chao Y, et al. Spider angiomas in patients with liver cirrhosis: role of vascular endothelial growth factor and basic fibroblast growth factor. World J Gastroenterol. Dec 2003;9(12):2832-5. [Medline]. [Full Text].

  13. Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, et al. Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function. Scand J Gastroenterol. May 1999;34(5):520-3. [Medline]. [Full Text].

  14. Iino S. [Differentiation alcoholic liver cirrhosis from viral liver cirrhosis]. Nippon Rinsho. Jan 1994;52(1):174-80. [Medline].

  15. Collyer J, Boone SL, White LE, Rademaker A, West DP, Anderson K. Comparison of treatment of cherry angiomata with pulsed-dye laser, potassium titanyl phosphate laser, and electrodesiccation: a randomized controlled trial. Arch Dermatol. Jan 2010;146(1):33-7. [Medline]. [Full Text].

  16. Sivarajan V, Al Aissami M, Maclaren W, Mackay IR. Recurrence of spider naevi following treatment with 585 nm pulsed dye laser. J Plast Reconstr Aesthet Surg. 2007;60(6):668-71. [Medline]. [Full Text].

  17. Clark C, Cameron H, Moseley H, Ferguson J, Ibbotson SH. Treatment of superficial cutaneous vascular lesions: experience with the KTP 532 nm laser. Lasers Med Sci. 2004;19(1):1-5. [Medline]. [Full Text].

  18. Bjerring P, Christiansen K, Troilius A. Intense pulsed light source for treatment of facial telangiectasias. J Cosmet Laser Ther. Dec 2001;3(4):169-73. [Medline]. [Full Text].

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  20. Michel JL. Treatment of hemangiomas with 595 nm pulsed dye laser dermobeam. Eur J Dermatol. Mar-Apr 2003;13(2):136-41. [Medline].

  21. Tan E, Vinciullo C. Pulsed dye laser treatment of spider telangiectasia. Australas J Dermatol. Feb 1997;38(1):22-5. [Medline]. [Full Text].

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Large spider angioma on the left cheek of a child.
The spider angioma has been compressed and is refilling rapidly from the central vessel.
A spider nevus consists of a central arteriole with radiating thin-walled vessels. Compression of the central vessel produces blanching and temporarily obliterates the lesion. When released, the threadlike vessels quickly refill with blood from the central arteriole. The ascending central arteriole resembles a spider's body, and the radiating fine vessels resemble multiple spider legs.
Multiple spider angiomas in a patient with cirrhosis.
 
 
 
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