Skin Conditions: Differential Diagnosis

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Chief Complaint

The fifth patient is a Caucasian guy in his middle years who complains of several red, oval-shaped lumps on his chest that bleed when rubbed or sliced open.

History of the Illness

The patient has red moles that first appeared in their early 30s and have grown in size and number over time.

Objective Data

The physical examination reveals that patient 5 has chest skin growths known as lesions that range in size from little red macules to bigger dome-topped polypoid papules. The lesions fluctuate in color from brilliant red to dark red, based on their stage of development and the damage that has been administered to them.

Assessment

Differential Diagnosis

Acute urticarial infection is one of the possible diagnoses in this situation. It alludes to a skin vascular response. Clinical manifestations include erythematous, smooth, slightly raised papules and plaques that are frequently accompanied by excruciating itching. Urticarial, on the other hand, is self-limited and transient, unlike in the current situation. The papules continue for few hours to many days until they disappear without leaving any scars and without any medical treatment (Guastafierro et al., 2019). Recurrence of the lesions occurs in chronic urticarial instances, and this can extend for up to six weeks. Additionally, the lesions response is ad hoc because it doesnt target any one bodily region.

Furthermore, an alternative diagnosis is an insect bite from a blood-feeding insect, such as a bed bug. When bitten by one of these insects, blood-filled sores develop in the bite region hours after the attack. In contrast to the existing situation, the lesion from blood-feeding bug bites can be up to 6 cm in size and gets worse just after sleep episodes. Additionally, they mostly manifest linearly in exposed body regions like the face, arms, and legs, and they move about as a result of fresh bites.

Moreover, another possible differential diagnosis, in this case, is bacillary angiomatosis. It refers to the appearance of many red, purple, flesh-colored, or colorless Cutaneous lesions ranging in size from 1 mm to 10 mm. Since they are caused by immunodeficiency, those who are immunocompromised, such as those who are HIV positive, are more likely to contract them. Contrary to the current situation, the oral mucosa, tongue, oropharynx, nose, penis, and anus are predominantly affected by the lesions. Other symptoms such as bone pain, fever, chills, malaise, night sweats, anorexia, and weight loss are also present along with the lesions.

Melanoma is another differential diagnosis that alludes to a specific form of skin cancer. Skin alterations such as a skin sore that does not heal, a hard red lump that bleeds when scratched, and a flat, red patch that is rough, dry, or scaly are examples of clinical presentation (Swetter & Geller, 2018). Melanocytes, the cells that produce pigment, undergo a mutation that leads to the development of malignant cells. Most of the chest and back are affected by the lesions. However, women experience it more frequently than men do.

Most Likely Correct Diagnosis

Cherry Angioma is the most probable correct diagnosis in this case. It refers to a skin tumor caused by an expansion of blood capillaries. It affects 60% of individuals and is more frequent in elderly persons over the age of 30. It is distinguished by oval-shaped lesions that range in color from brilliant red owing to dilated capillaries to dark red when pressure is applied, bleed when scratched, and grow in size and quantity as the patient ages (Espinosa et al., 2018). When the lesions burst open, they are painless yet irritating. Angiomas mostly affect the chest, stomach, and back, and they frequently arise in clusters.

Plan of Care

The treatment approach emphasizes aesthetics because the lesions are often painless and pose minimal health risks. It is advised to remove the lesion from the skin using an excision procedure. To lessen discomfort throughout the procedure, anesthesia is used. Electrodesiccation, which includes burning the skin growth with an electric needle to obliterate the blood vessels, is another method for getting rid of them. Both procedures, nevertheless, result in scarring. When eliminating traumatic lesions where scarring is a concern, a biopsy is preferable.

References

Espinosa Lara, P., Medina-Puente, C., Riquelme Oliveira, A., & Jiménez-Reyes, J. (2018). Eruptive cherry angiomas developing in a patient treated with ramucirumab. Acta Oncologica, 57(5), 709-711. Web.

Guastafierro, A., Verdura, V., Di Pace, B., Faenza, M., & Rubino, C. (2019). The influence of breast cancer on the distribution of cherry angiomas on the anterior thoracic wall: A case series study. Dermatology, 235(1), 65-70. Web.

Swetter, S., & Geller, A. C. (2018). Melanoma: Clinical features and diagnosis. U: UpToDate.

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