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Chapter 054. Skin Manifestations of Internal Disease (Part 23)

Blue Lesions Lesions that are blue in color are the result of either vascular ectasias and tumors or melanin pigment in the dermis. Venous lakes (ectasias) are compressible dark-blue lesions that are found commonly in the head and neck region. Venous malformations are also compressible blue papulonodules and plaques that can occur anywhere on the body, including the oral mucosa. When there are multiple rather than single congenital lesions, the patient may have the blue rubber bleb syndrome or Mafucci's syndrome. Patients with the blue rubber bleb syndrome also have vascular anomalies of the gastrointestinal tract that may bleed,. | Chapter 054. Skin Manifestations of Internal Disease Part 23 Blue Lesions Lesions that are blue in color are the result of either vascular ectasias and tumors or melanin pigment in the dermis. Venous lakes ectasias are compressible dark-blue lesions that are found commonly in the head and neck region. Venous malformations are also compressible blue papulonodules and plaques that can occur anywhere on the body including the oral mucosa. When there are multiple rather than single congenital lesions the patient may have the blue rubber bleb syndrome or Mafucci s syndrome. Patients with the blue rubber bleb syndrome also have vascular anomalies of the gastrointestinal tract that may bleed whereas patients with Mafucci s syndrome have associated dyschondroplasia and osteochondromas. Blue nevi moles are seen when there are collections of pigment-producing nevus cells in the dermis. These benign papular lesions are dome-shaped and occur most commonly on the dorsum of the hand or foot or in the head and neck region. Violaceous Lesions Violaceous papules and plaques are seen in lupus pernio lymphoma cutis and cutaneous lupus. Lupus pernio is a particular type of sarcoidosis that involves the tip and alar rim of the nose as well as the earlobes with lesions that are violaceous in color rather than red-brown. This form of sarcoidosis is associated with involvement of the upper respiratory tract. The plaques of lymphoma cutis and cutaneous lupus may be red or violaceous in color and were discussed above. Purple Lesions Purple-colored papules and plaques are seen in vascular tumors such as Kaposi s sarcoma Chap. 182 and angiosarcoma and when there is extravasation of red blood cells into the skin in association with inflammation as in palpable purpura see Purpura below . Patients with congenital or acquired AV fistulas and venous hypertension can develop purple papules on the lower extremities that can resemble Kaposi s sarcoma clinically and histologically this condition is .