spider nevus ( also known as spider angioma or vascular spider ) is a common benign vascular anomaly that may appear as solitary or multiple lesions . spider nevi are represented by telangiectases that consist of a large arteriole from which radiate numerous small vessels that resemble spider 's legs . they are found in the distribution of the superior vena cava , that is , on the face , neck , arms , and upper trunk . spider nevi are usually < 2 cm in diameter and rarely grow to assume large size more than 2 cm . we hereby report a case of very large spider nevus in a patient with hepatitis c virus ( hcv ) related liver cirrhosis . a 48-year - old - female presented with a history of abdominal distension and jaundice of 3-month duration . physical examination revealed pallor , icterus , pedal edema , hepatospleenomegaly and tense ascites . she had multiple classical spider nevi over the chest . also , she had a large spider nevi situated on the forehead , measuring 8 cm in largest dimension with palpable dilated vessels and venous hum [ figure 1 ] . deep compression on the central area of the lesion produced complete disappearance with blanching and when released refilling of vessels occurred . laboratory tests revealed a hemoglobin level of 9.8 g / dl , a white - cell count of 4240/mm , and a platelet count of 77,000/mm . anti - hcv antibody for hcv was positive with hcv rna of 1.6  10 iu / ml . an ultrasound abdomen was suggestive of liver cirrhosis with portal hypertension ( portal vein diameter of 14 mm ) , ascites and splenomegaly . thus , a diagnosis of cirrhosis liver with portal hypertension was made ( ctp-9 , class b , and meld  11 ) . she was put on diuretics for the control of ascites but developed hepatic encephalopathy and renal dysfunction . diuretics were stopped and in view of refractory tense ascites , she was taken up for a transjugular intrahepatic portosystemic shunt . however , during the procedure she had massive intrahepatic bleed and in spite of intensive resuscitative measures she died 48 hours later . spider nevi can be seen in pregnancy , in patients with thyrotoxicosis , rheumatoid arthritis , oral contraceptive use and most commonly , liver cirrhosis . these frequently appear in alcoholic cirrhotic or when liver function deteriorates in patients of the chronic liver disease . found elevated levels of vascular endothelial growth factor and basic fibroblast growth factor in patients with liver cirrhosis , especially in those with spider nevi . in patients with nonalcoholic cirrhosis , the levels of substance p are elevated which may play an important role in the pathogenesis of spider nevi by causing vasodilatation . most remain small in size and rarely do they assume the size as seen in our patient . the present case is unique because of its very large size , rare presentation over the forehead and palpable mass like vascular lesion in a patient with nonalcoholic cirrhosis . electrodesiccation and laser treatments under local anesthesia are effective therapeutic procedures for facial spider nevi . spider nevi , however , usually do not require any treatment in cirrhotic patients due to a high risk of bleeding from these vascular lesions .
spider nevi are benign vascular lesions mostly seen in patients with decompensated liver cirrhosis . mostly , these are seen in the superior vena cava distribution and are small with pinhead size central vessel . 
 giant spider nevus is rarely seen and hence this report .