A streaky blanching spot on the lateral forearm with a palpable pulse and high estrogen levels most likely represents which lesion?

• A. Hemangioma
• B. Port-wine stain
• C. Nevus flammeus
• D. Spider telangiectasia

Answer: (D)

Spider telangiectasia are small, dilated superficial arteries with a central feeding vessel and radiating tiny vessels. They blanch when pressed because the blood in superficial vessels is displaced, and the central arterial component can feel like a pulse. They are classically seen in states with high estrogen, such as pregnancy or liver disease, making the finding on a person with elevated estrogen levels highly consistent. The streaky blanching spot on the forearm fits this pattern of a spider-like vascular lesion.

Port-wine stains (nevus flammeus) are congenital capillary malformations that appear flat and reddish-purple at birth and do not typically present with a central pulsatile vessel. Hemangiomas are usually infantile, bright-red, and not specifically tied to estrogen elevations; they also don’t present as a pulsatile, radiating vascular pattern. So the described presentation aligns best with spider telangiectasia.