Clinical Challenge: Erythematous Papule on the Thigh - MPR

Clinical Challenge: Erythematous Papule on the Thigh

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A 44-year-old woman is referred for evaluation of an asymptomatic lesion on her right thigh that she first noticed approximately 2 months ago. The lesion is asymptomatic and does not bleed. The patient’s medical history is negative for systemic disease. Examination reveals a 0.5cm erythematous papule with mild tenderness elicited upon palpation. Dermoscopy reveals a nonspecific globular exophytic lesion with arborizing vessels.

Biopsy of the lesion was performed and revealed a superficial angiomyxoma. Superficial angiomyxomas, also referred to as cutaneous angiomyxomas, are rare, well-demarcated neoplasms composed of myxoid nodules that contain thin-walled capillaries and spindle-shaped or stellate fibroblasts.1,2 These lesions more commonly occur...

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Biopsy of the lesion was performed and revealed a superficial angiomyxoma. Superficial angiomyxomas, also referred to as cutaneous angiomyxomas, are rare, well-demarcated neoplasms composed of myxoid nodules that contain thin-walled capillaries and spindle-shaped or stellate fibroblasts.1,2 These lesions more commonly occur in middle-aged men and may affect the trunk, head and neck, and extremities.2 Dermoscopy is often nonspecific but may reveal what has been described as “the red planet sign,” a red, translucent, globular exophytic lesion with arborizing vessels that resembles a blood moon during a lunar eclipse.3,4  

Solitary superficial angiomyxomas are benign and can be removed by surgical excision. While a single lesion is typically of no clinical importance, the presence of multiple lesions may indicate the Carney complex, an autosomal-dominant disorder characterized by cardiac myxomas and the propensity to develop internal malignancies.5  

Nelson Maniscalco, DPM, is a joint podiatry/dermatology fellow under the aegis of St. Luke’s Medical Center in Allentown, Pennsylvania, and the DermDox Center for Dermatology. Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, associate professor of medicine at Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Kura MM, Jindal SR. Solitary superficial acral angiomyxoma: an infrequently reported soft tissue tumorIndian J Dermatol. 2014;59(5):529.  

2. Zou Y, Billings SD. Myxoid cutaneous tumors: a reviewJ Cutan Pathol. 2016;43(10):903-918.

3. Green M, Logemann N, Sulit DJ. Myxoid stroma and delicate vasculature of a superficial angiomyxoma give rise to the red planet signDermatol Online J. 2014;20(9):25244175.

4. Abarzúa-Araya A, Lallas A, Piana S, Longo C, Moscarella E, Argenziano G. Superficial angiomyxoma of the skinDermatol Pract Concept. 2016;6(3):47-49.

5. Kamilaris CDC, Faucz FR, Voutetakis A, Stratakis CA. Carney complexExp Clin Endocrinol Diabetes. 2019;127(02-03):156-164.