Benign lesions - angioma and other vascular lesions
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Angiomas are benign vascular tumors that have the dermoscopic features of lacunae and septae. These features are found independent of the color of the skin. Angiomas can have colors that vary from a light pink to a deep purple regardless of the skin type. Whether angiomas are more likely to be lighter pinks in light-skinned persons and darker reds and purples in dark skinned persons is possible but not proven.
- Dark lacunae: sharply demarcated, ovoid structures with a dark blue, dark violaceous or black color.
- Blue-White veil: confluent blue pigmentation with an overlying whitish haze.
- Ulceration and surface scale may be present.
- Rarely, a rainbow pattern may be present.
Pyogenic granuloma (PG) is a relatively common benign acquired friable vascular growth of the skin and mucous membranes often started by trauma. PG is a misnomer as it is neither pyogenic nor granulomatous. However, it often has a purulent-appearing exudate that explains how it got its name. A more accurate name in use is “lobular capillary hemangioma”.
- Reddish or red-whitish homogeneous area: a structureless zone whose color varies from completely red to red with whitish zones.
- White collarette: a ring-shaped or arcuate squamous structure that is usually located at the periphery of the lesions.
- White rail lines: white streaks that intersect the lesion.
- Vascular structures (dotted vessels, hairpin vessels, linear-irregular vessels, telangiectasias, polymorphous vessels).
- Ulceration may be present
The most frequent dermoscopic pattern of PG consists of reddish homogenous areas separated by white lines resembling rails and surrounded by a white collarette. Dermoscopy of pyogenic granulomas are not known to vary by skin type.
Low-grade malignant vascular tumor caused by human herpesvirus-8 (HHV-8) producing a vascular proliferation.
- Homogeneous pattern with differing colors (i.e., whitish, pinkish, reddish, bluish, or violaceous) in different lesions in the same patient.
- Rainbow-like appearance: multicolored areas showing various colors of the rainbow spectrum.
- Whitish structureless areas, vascular structures, scale, and a white collarette may also be seen.
Malformation involving lymphatic vessels that may be present at birth or occur later typically from trauma (including postsurgical). The clinical appearance has been described as looking like frog spawn. There is no known variation based on skin color.
Note how this resembles the hyphema that might be seen in an eye that has experienced trauma in which there is bleeding in the anterior chamber:
This has been incorrectly compared to hypopyon which consists of white blood cells that create a white layer at the bottom of the anterior chamber in iritis: 
Courtesy of the Color Atlas and Synopsis of Family Medicine. Usatine R, Smith M, Mayeaux EJ, Chumley H. The Color Atlas and Synopsis of Family Medicine, 3rd Edition. McGraw-Hill, New York, 2018.
I suggest it is time to rename the sign the “hyphema sign”.
Links to additional chapters on Skin of Color
- Zaballos et al.: Dermoscopy of solitary angiokeratomas: a morphological study. Arch Dermatol 2007;143:318-25. PMID: 17372096. DOI.
- Zaballos et al.: Dermoscopy of pyogenic granuloma: a morphological study. Br. J. Dermatol. 2010;163:1229-37. PMID: 20846306. DOI.
- Cheng et al.: Rainbow pattern in Kaposi's sarcoma under polarized dermoscopy: a dermoscopic pathological study. Br. J. Dermatol. 2009;160:801-9. PMID: 19067686. DOI.
- Vázquez-López et al.: Dermoscopic rainbow pattern in non-Kaposi sarcoma lesions. Br. J. Dermatol. 2009;161:474-5. PMID: 19438855. DOI.
- Gencoglan et al.: Hypopyon-like features: new dermoscopic criteria in the differential diagnosis of cutaneous lymphangioma circumscriptum and haemangiomas?. J Eur Acad Dermatol Venereol 2012;26:1023-5. PMID: 21645121. DOI.