A spider angioma or spider naevus is a type of telangiectasis found slightly beneath the skin surface, often containing a central arteriole and many small vessels whichradiate outwards like a spider’s web. Applying pressureto the center of the lesion leads to fading of the lesion.Spider angioma is a common presentation of liver cirrhosis, especially alcoholic cirrhosis. Spider angiomas arefound only in the distribution of the superior vena cava,and are thus commonly found on the face, neck, upperchest and upper arm. Spider angioma is rarely observedon hand (1, 2). Here, we report a a very rare case withspider angioma on back of hand.A 54-year-old male patient admitted to our clinic with icterus and ascites. The patient had a diagnosis of alcoholicliver cirrhosis one month before. On physical examination, he had icterus and ascites. He had spider angiomason his back, neck and on the back of his right hand just proximal to second metacarpophalangeal joint (Figure 1). The patient’s Child Turcotte Pugh score (CTP) andmodel for end stage liver disease (MELD) scores were 12and 22, respectively. Abdomen ultrasound showed cirrhosis with massive ascites. Endoscopy revealed grade 1esophageal varices and portal hypertensive gastropathy.The patient gave written consent regarding this article.Spider angioma appears frequently in alcoholic cirrhoticor noncirrhotic alcoholic liver diseases with deuteriationof liver functions. Although, the exact cause of SA is notknown, there have been many theories of possible etiologicfactors such as disturbance of sex hormones (increased level of luteinizing hormone, decreased level of testosteroneand a higher estradiol/testosterone ratio), angiogenesis,vasodilation, alcohol abuse, hyperdynamic circulation state, and liver dysfunction[3, 4]. The number and size of SAare correlated with the degree of liver disease (1, 3, 4). Our patient was a heavy drinker and had alcoholic livercirrhosis with high CTP and MELD score. Although, ourpatient had multiple telangiectasias, it is a very rare finding of SA, observed on back of hand. All of the authors declare no conflict of intererest regarding this article. All of of the authors have no financial interest regarding this article. The study was conducted in accordance with the Declaration of Helsinki Ethical Principles.