Kiss of the spider or something more?

March 12, 2020

The parents of a healthy 8-year-old girl are worried about an asymptomatic red spot on their daughter’s left cheek that has been enlarging for more than a year. What's the diagnosis?

The case

The parents of a healthy 8-year-old girl are worried about an asymptomatic red spot on their daughter’s left cheek that has been enlarging for more than a year.

Diagnosis: Spider angioma

Spider angiomas are a benign vascular malformation commonly found in infants and children.

Also known as spider nevus, spider telangiectasia, vascular spiders, and nevus aranei, a spider angioma is an arterial vascular malformation attributed to idiopathic dilation of central arterioles just beneath the skin surface.1 These lesions occur in children often on the face, forearms, and hands. On exam, a spider angioma appears as a central pink to red macule with symmetrically radiating branches that blanche with pressure.2 These lesions are underreported and likely represent an exceedingly common benign finding.

An observational study in Dublin, Ireland, found that 38% of children aged 1 to 15 years without any signs of liver disease had at least 1 spider angioma, and often 1 to 4 spider angiomas were found.3 Another study in Bristol, England, found that 47.5% of healthy children aged 3 to 17 years had at least 1 spider angioma.4 In contrast, the sudden appearance of multiple spider angiomas in adults may be associated with underlying liver disease, pregnancy, or estrogen therapy. The lesions may regress on their own or remain throughout life.2 Bleeding from the lesions is uncommon unless the spots are picked or traumatized.

Management

No intervention is necessary. However, electrocoagulation, pulsed dye laser, and neodymium-doped yttrium aluminum garnet (Nd:YAG) are possible treatments.5 When lesions have been traumatized or become elevated and pose a risk of bleeding, laser treatment is effective and associated with a very low risk of scarring.

Patient outcome

 

The spider angioma was not symptomatic, so the family opted to monitor their daughter’s benign lesion clinically.

References:

1. Samant H, Kothadia JP. StatPearls: Spider angioma [Internet]. Treasure Island, FL: StatPearls Publishing LLC; July 1, 2019. Updated December 11, 2019. Accessed January 29, 2020.

2. Vascular disorders of infancy and childhood. In: Paller AS, Mancini AJ (eds). Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. 3rd ed. Philadelphia, PA: WB Saunders;  2006:307.

3. Finn SM, Rowland M, Lawlor F, et al. The significance of cutaneous spider naevi in children. Arch Dis Child. 2006;91(7):604-605.

4. Alderson MR. Spider naevi-their incidence in healthy schoolchildren.Arch Dis Child. 1963;38:286-288.

 

5. Scheepers JH, Quaba AA. Treatment of nevi aranei with the pulsed tunable dye laser at 585 nm. J Pediatr Surg. 1995;30(1):101-104.