Sunday, August 11, 2013

Hemorrhagic Blister

Abstract: A 58-year-old man with 2-day history of deep purple to black papule

History: A 58-year-old man presents for evaluation of a skin lesion on the right lower abdomen that has been present approximately 2 days. The patient does not remember having any trauma on that area. It seems the lesion appeared quite abruptly and the color has been darkened over past 2 days. No history of non-melanoma skin cancers or melanoma.

O/E: The skin exam shows a healthy and pleasant man with skin type III. There is a sharply demarcated 6 mm deep dark purple oval shaped papule on the right lower abdomen. It is somewhat compressible.

Clinical & Dermatoscopic Photos:

Polarized Dermatoscopic Photo
Non-Polarized Dermatoscopic Photo

Diagnosis: Hemorrhagic blister

Discussion: The lesion was lanced with an 11 blade. Blood product was drained and confirmed the diagnosis of hemorrhagic blister. Initially, the lesion did not obviously look as  a hemorrhagic blister. The dermatoscopic image did not show a typically appearing hemangioma. Our biggest concern was to make sure this is not a melanoma. Conventionally, melanoma would not appear in a 2-day period. A careful history led us to consider a hemorrahagic blister with a simple lancing. 

1. Bullous malignant melanoma: an unusual differential diagnosis of a hemorrhagic friction blister.
Vogt T, Brunnberg S, Hohenleutner U, et al. Dermatol Surg. 2003 29(1): 102-4



A 66-year-old woman presented to our outpatient clinic with a 3 x 2.5-cm tense, hemorrhagic-appearing bulla on her forefoot. Histopathology and immunohistochemistry confirmed a transtumoral-transepidermal blister formation within an advanced acrolentiginous malignantmelanoma (MM).


To study bullous malignant melanoma.


Blistering in MMs represents a rare but clinically important pitfall in clinical differential diagnosis. The blisters are typically due to the disruption of the cohesion between neoplastic cells and keratinocytes, but physical friction may also contribute.


Hemorrhagic blistering is, in many cases, a relatively insignificant finding in which frictional forces are imposed.


The case reported here underscores that in rare cases MMs, particularly if acrally located, can be complicated by hemorrhagic blistering. Because of the life-threatening consequences, one should be aware of this rare differential diagnosis.

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