Vascular lesions

From dermoscopedia

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Angiomangiomas are benign tumors derived from cells of the vascular or lymphatic vessel walls (endothelium) or derived from cells of the tissues surrounding these vessels.[1][2] Angiomas are a frequent occurrence as patients age, but they might be an indicator of systemic problems such as liver disease. They are not commonly associated with malignancy./Hemangioma

The most common vascular lesions in childhood are the hemangiomas of infancy and, in adulthood, the cherry hemangiomas. Hemangiomas are benignThis glossary term has not yet been described. proliferations of blood vesselsThis glossary term has not yet been described..

DermoscopyDermoscopy is a non invasive diagnostic method.:

  • Absence of melanocyticThis glossary term has not yet been described. criteriaThis glossary term has not yet been described.
  • LacunaeThis glossary term has not yet been described. (also known as lagoons): well-demarcated, round to oval red, reddish-brown or reddish-blue areas that commonly vary in size and colorColor (American English) or colour (Commonwealth English) is the characteristic of human visual perception described through color categories, with names such as red, yellow, purple, or blue. within a given lesion. Lacunae may be either tightly clustered or loosely scattered throughout the lesion and they are often located on a background of red, red-blue, or red-white homogeneous color. No vascular structuresThis glossary term has not yet been described. must be seen inside the lacunaeThis glossary term has not yet been described..
  • Occasionally, individual dilated blood vessels or a red network of vesselsThis glossary term has not yet been described. may be visible.
  • Hemangiomas may develop a partial thrombosis, acquiring a focal blue-black color, or a total thrombosis manifesting a jet-black color.
Vascular Figure 1.jpg
Vascular Figure 2.jpg

AngiokeratomaThis glossary term has not yet been described. [1]

Angiokeratomas are acquired vascular lesions that present as shiny, soft, dark red to violaceous, 2–10 mm papules which may develop a blue-violaceous to black color and a surface scale. Four clinical subtypes of angiokeratomas have been described: solitary angiokeratomaThis glossary term has not yet been described. (the most common type), angiokeratoma of Mibelli, angiokeratoma of Fordyce, and angiokeratoma corporis diffusum.

Dermoscopy:

  • 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, rainbow patternCircumscribed structureless areas displaying colors of the whole spectrum of visible light may be present.

Pyogenic granulomaThis glossary term has not yet been described. (lobular capillary hemangioma) [2]

Common, benign, acquired, vascular lesionThis glossary term has not yet been described. of the skin and mucosa. Typically presents in children or young adults as a solitary, rapidly growing, red papule or nodule that tends to ulceration and bleeding. They are related to infective organisms, penetrating injury, hormonal factors (pregnancyThis glossary term has not yet been described.), retinoid therapy, or other systemic medications (i.e., docetaxel).

Dermoscopy (figure 4):

  • Reddish or red-whitish homogeneous area: a structureless zone whose color varied 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 linesstreaks: white streakslines, radial (always at periphery) Reed nevus, melanoma, recurrent nevus that intersect the lesion.
  • Vascular structuresThis glossary term has not yet been described. (dotted vesselstiny pinpoint vessels flat melanocytic lesions inflammatory diseases Bowen disease, hairpin vessels, linear-irregular vessels, telangiectasias, polymorphous vesselsmultiple types of vessels are present may indicate malignancy in appropriate context for example in flat melanocytic lesions).
  • Ulceration may be present

The most frequent dermoscopic pattern of pyogenic granulomaThis glossary term has not yet been described. consists of reddish homogenous areas separated by white lines resembling rails and surrounded by a white collarette.

Vascular Figure 4.jpg

OTHER VASCULAR TUMORS:

Microvenular hemangiomaThis glossary term has not yet been described. [3]

Acquired, slowly growing, asymptomatic, benign vascular tumor that usually presents on the upper limbs, forearms, or trunk of young to middle-aged adults. It appears as sharply circumscribed, bright red, solitary lesions varying in size from 0.5 to 2 cm.
Dermoscopy:

  • Diffuse erythema with multiple well-demarcated small red globules of different sizes.
  • Peripheral fine pigment networkGrid-like pattern consisting of interconnecting pigmented lines surrounding hypopigmented holes.

Angioma serpiginosumThis glossary term has not yet been described. [4]

BenignThis glossary term has not yet been described. vascular disorder, characterized clinically by multiple minute, red-to-purple, grouped macules distributed in a serpiginous or gyrate pattern. Dermoscopy:

  • Numerous small, relatively well demarcated, round-to-oval red lacunae

    Port-wine stain:

Capillary malformation that is present at birth and persists throughout life. It may be localized or cover extensive areas of the skin surface.

Dermoscopy:

  • SuperficialThis glossary term has not yet been described. port-wine stain:
  • Red dotted and globular vessels
  • Deep port-wine stain:
  • Dilated linear and tortuous vessels
  • Gray-whitish veil
  • Pale circular areas surrounding a central brownish dotSee [[Glossary:Dots|Dots]]
  • Mixed pattern: dermoscopic characteristics from either superficialThis glossary term has not yet been described. and deep port-wine stain

Lymphangioma circumscriptumThis glossary term has not yet been described. [5]

Vascular malformation involving primarily the lymphatic vessels. Clinically, it appears as numerous small vesicle-like lesions grouped in a plaque.

Dermoscopy:

Lacunar pattern composed of :

  • Clear to tan lacunae surrounded by pale septa if there is no inclusion of blood in the lacunae
  • Yellow to pink lacunae alternating with dark red or bluish lacunae, if there is inclusion of blood in the lacunae
  • Hypopyon-like feature (half and half blIster): a sign observed when the blood inside the lacunae accumulates in the lowest part of the lacunae due to sedimentation, resembling the appearance of the hypopion in the eye

    Targetoid hemosiderotic hemangiomaThis glossary term has not yet been described. (hobnail hemangioma) [6]

Uncommon, benign, solitary, vascular lesion of lymphatic origin. The classic clinical presentation is as single, annular, targetoid-appearance vascular lesion with a brown to violaceous central papule surrounded by a thin, pale area and a peripheral ecchymotic ring. Patients usually describe cyclic changes in their lesions. Dermoscopy(Figure 5)::

  • Central area with red and dark lacunae
  • Peripheral circular reddish-violaceous homogeneous area
  • Sometimes, intermediate skinThis glossary term has not yet been described.-coloured, yellow or white circular homogeneous area.
  • Occasionally, a reddish-violaceous or ecchymotic homogeneous area occupies the whole lesion.
  • A peripheral delicate pigment network, white structures (white shiny lines) may be present.
Vascular Figure 5.jpg

Kaposi’s Sarcoma [7][8]

Vascular proliferation caused by human herpesvirus-8 (HHV-8). It is considered a low-grade malignantThis glossary term has not yet been described. vascular tumor. There are four recognized clinical subsets of Kaposi’s sarcoma: classic, endemic, iatrogenic, and HIV related. Clinically the cutaneous lesions begin as reddish-blue macules or plaques that gradually enlarge and become nodularThis glossary term has not yet been described.. Dermoscopy (Figure 6):

  • Homogeneous patternA pattern lacking any definable pigment structures, structureless 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. This sign is no pathognomonic of Kaposi’s sarcoma and it is only seen with polarized lightThis glossary term has not yet been described. dermoscopyDermoscopy is a non invasive diagnostic method.. Whitish structureless areas, vascular structures, scale, and a white collarette may also be seen.
    Vascular Figure 6.jpg

AngiosarcomaThis glossary term has not yet been described. [9]

Aggressive neoplasm which is mainly divided into three variants: angiosarcomaThis glossary term has not yet been described. of the head and scalp, lymphoedema-associated angiosarcoma and radiation-induced angiosarcoma. It is characterized by a tendency to metastasize to regional lymph nodes and lungs. Prognosis is poor. Clinically, early lesions develop as ill-defined violaceous to bluish areas with an indurated border and advanced lesions become elevated or nodular and occasionally ulcerated. Dermoscopy:

  • Homogeneous pattern with combinations of colors (i.e., whitish, pinkish, reddish, bluish, or violaceous)
  • White lines at the nodular parts.


    References:
  • 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.
  • Scalvenzi et al.: Dermoscopy of microvenular hemangioma: report of a case. Dermatology (Basel) 2007;215:69-71. PMID: 17587844. DOI.
  • Ohnishi et al.: Angioma serpiginosum: a report of 2 cases identified using epiluminescence microscopy. Arch Dermatol 1999;135:1366-8. PMID: 10566835.
  • 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.
  • Zaballos et al.: Dermoscopy of Targetoid Hemosiderotic Hemangioma: A Morphological Study of 35 Cases. Dermatology (Basel) 2015;231:339-44. PMID: 26458032. 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.
  • Zalaudek et al.: Clinical, dermoscopic and histopathological features of spontaneous scalp or face and radiotherapy-induced angiosarcoma. Australas. J. Dermatol. 2013;54:201-7. PMID: 22943153. DOI.