Differentiating deep blue lesions

Blue tumours on the skin like this are always interesting. If they are compressible, then they are vascular, but if not then consider metastatic melanoma, agminated blue naevi, Kaposi’s sarcoma and cutaneous lymphoma.

These were compressible and there were other single blue tumours elsewhere on his body. An excision biopsy of one of the lesions revealed it to be a glomangioma. These are vascular tumours composed of vessels, smooth muscle and glomus cells. The latter act to regulate blood flow between the arterial and venous systems in the skin. Usually glomus tumours are found under the nail and present with a bluish subungual discolouration and local pain. Rare cases of multiple glomangiomas have been reported with neurofibromatosis, so check for multiple café au lait spots and axillary freckling. For other images see www.skinconsult.com.au