Case #12 Discussion

Summary: This is a pigmented, localized surface lesion   ~Pigmented – Dark red and blue   ~Localized Lesions to Exclude from the Differential Diagnosis: Intravascular Lesions   ~Do not blanch Tattoo   ~Color   ~Lesion is very large for a tattoo Melanocytic lesions   ~Color Vascular Lesions   ~Blanch on pressure Hematoma   ~Thickened Petechiae   ~Appearance – round, red pinpoints Lesions to Include in the Differential Diagnosis: Ecchymosis   ~Does not blanch   ~Is not thickened   ~This bruising has a typical pattern from fellatio, wretching, or coughing Management: Once the diagnosis is established, no treatment is required.  Explain the nature of the lesion to the patient.  Record findings and diagnosis in the patient’s chart.  Remember that vomiting and wretching can also result in ecchymosis of the soft palate. Final Diagnosis: Ecchymosis, in this case secondary to fellatio