Presenter: Dr. Suzanne Sirota Rozenberg, PGY3, Dr. Norma Montiel, PGY2

Dermatology Program: St. Johns Episcopal Hospital, South Shore, Far Rockaway, New York

Program Director: Marvin Watsky, D.O.

Submitted on: September 1, 2004

CHIEF COMPLAINT: Enlarging skin lesion since the birth of the right forearm, wrist, and hand

CLINICAL HISTORY: A 1-month-old female presents with an enlarging skin lesion since the birth of the right forearm, wrist, and hand. The mother states that the lesion has been present since the baby was born and has been getting bigger. The child demonstrates a full range of motion of the arm, no crying, crankiness, or failure to thrive. No previous treatments. The patient was born prematurely at 35 weeks and demonstrated no postnatal complications.

PHYSICAL EXAM:
On the physical, an erythematous and violaceous papule extending from the forearm to the wrist to the hand and thumb was noted. Easy compressibility and blanching were present. No ulceration or active bleeding was noted. Wrist circumference of the right was 10 ½ cm and the left was 10cm. forearm to the wrist 9 cm on the right and 9 ½ cm on the left. Pt was noted to have a sacral dimple and overlying Mongolian spot as well

LABORATORY TESTS:

Ultrasound of the lumbosacral spine was unremarkable. Head CT was also unremarkable. Genetic testing showed a normal 46 XX karyotype. All other tests at birth were normal.

DERMATOHISTOPATHOLOGY:

No biopsy was done on this baby.

DIFFERENTIAL DIAGNOSIS:

1.   Infantile hemangioma
2.   Vascular malformation
3.   Kasabach-Merritt syndrome
4.   Angioma
5.   Klippel- Trenaunay syndrome