The clinical diagnosis is angiokeratoma of the scrotum, also known as angiokeratoma of Fordyce or Fordyce angiokeratoma. They are typically asymptomatic, 2–5 mm in size, blue to red papules. There may be a scaly surface. It is a relatively common condition and is more prevalent among people older than 40 years. Histologically there are
dilated ectatic capillaries with epidermal hyperplasia.
People may worry about sexually transmitted disease especially if it bleeds after sexua| activity. Solitary thrombosed angiokeratoma may appear like melanoma.
There are four clinical types: angiokeratoma of Fordyce, sporadic angiokeratoma, angiokeratoma circumscriptum and Fabry disease(angiokeratoma corporis diffusum). Except for Fabry disease, they are harmless. Fabry disease is a rare serious inherited metabolic disorder with widespread angiokeratoma and it may be associated with systemic involvement including renal failure, heart failure, strokes
and, corneal opacities. Patients with Fabry disease may also report lancinating limb pain.It is most commonly found on the scrotum. There may be a few to many (>100) lesions. They may also be found on the shaft of the penis,
labia majora of the vulva, inner thigh and lower abdomen.
The patient should be reassured about the benign nature. Most lesions are harmless and require no treatment. Treatment options include removal by electrocautery, cryotherapy or laser. Diagnostic skin biopsy should be considered if the lesion resembles melanoma.