Atypically located spider angioma

To the Editor,
 A spider angioma or naevus is a type of telangiectasis found slightly beneath skin surface, often containing central arteriole and many small vessels which radiate outwards like spider's web. Applying pressure to center lesion leads fading lesion. Spider common presentation liver cirrhosis, especially alcoholic cirrhosis. angiomas are only in distribution superior vena cava, thus commonly on face, neck, upper chest arm. rarely observed hand (1, 2). Here, we report very rare case with back hand.
 54-year-old male patient admitted our clinic icterus ascites. The had diagnosis cirrhosis one month before. On physical examination, he He his back, neck right hand, just proximal second metacarpophalangeal joint (Figure 1). patient’s Child Turcotte Pugh score (CTP) model for end stage disease (MELD) scores were 12 22, respectively. Abdomen ultrasound showed massive Endoscopy revealed grade 1 esophageal varices portal hypertensive gastropathy. gave written consent regarding this article.
 appears frequently cirrhotic noncirrhotic diseases deuteriation functions. Although, exact cause SA not known, there have been theories possible etiologic factors such as disturbance sex hormones (increased level luteinizing hormone, decreased testosterone higher estradiol/testosterone ratio), angiogenesis, vasodilation, alcohol abuse, hyperdynamic circulation state, dysfunction[3, 4]. number size correlated degree 3, 4). 
 Our was heavy drinker high CTP MELD score. multiple telangiectasias, it finding SA, hand.