funDERMentals

The Lesion with Legs


 

No one in the family is certain when this 6-year-old boy first developed the red spot on his nose, but it is increasingly noticeable. And with school picture day approaching, they would like the redness to resolve.

Their primary care provider reassured them, at length, that it was benign and would eventually resolve without treatment. The lesion causes no symptoms and is purely a cosmetic concern.

The child is otherwise healthy and has been since birth.

EXAMINATION
A pinpoint red dot can be seen on the upper nasal bridge, just to the right of the midline. Tiny linear red “legs” extend from the central dot, like spokes on a wheel. In aggregate, the lesion measures about 3 mm in diameter. There is no palpable component.

However, the entire lesion is blanchable: Pinpoint pressure on the central dot causes it to blanch, and as the pressure is released, the legs of the lesion refill immediately from the center outward. When a glass slide is pressed against the lesion (a process called diascopy) and then released, the same process occurs.

What is the diagnosis?

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