Other Vascular Tumors

Angiokeratoma circumscriptum (64) is usually present at birth and is characterized -g by multiple, keratotic, vascular papules, that may appear individually or forming larger plaques. The lesions are bluish, with a verrucous surface, and may show linear arrangement (Fig. 17). Histopathological examination shows hyperkeratosis, papil- c lomatosis, and irregular acanthosis. Multiple vascular spaces filled with blood are evident in the papillary dermis.

Angiokeratoma Mibelli is an autosomal dominant condition characterized by multiple keratotic vascular papules of the distal extremities in association with cold intolerance. Lesions appear in infancy, predominantly on acral sites, such as fingers and toes. There is a slight predominance in female patients. Histological examination

Figure 17 Angiokeratomas are congenital vascular papules or nodules with keratotic surface. Acral lesions of the foot may be associated with cold intolerance.

shows, ectatic blood vessels in the papillary dermis, with an overlying keratotic epidermis.

Pyogenic granuloma (65) is a confusing term that defines a proliferation of granulation tissue secondary to trauma. The lesions appear at any age and in patients of both genders. The tumor appears clinically as a red- to- purple vascular nodule of variable size. Common sites include the fingers, toes, lips, oral mucosa, and trunk. Lesions are usually single and bleed easily. On histological examination there is a proliferation of dermal blood vessels in a gelatinous stroma, surrounded by fibroblasts, neutrophils, and mast cells. The epidermis forms a collarette at the base of the lesion.

Glomus tumor (66) presents as a single bluish nodule on acral sites. Frequently it is subungual and tender. There are some familial cases inherited in autosomal dominant fashion. Histological examination shows dermal vascular spaces and glo-mus cells arranged around endothelial cells. Glomus cells are cuboidal and have a central rounded nucleus.

Lymphangioma (67) is noted at birth or immediately after. It presents as a a collection of small, deep vesicles resembling frog spawn. Favorite locations include the trunk, axillae, shoulders, neck, extremities, and oral mucosa. On histological d examination, there are dilated lymphatic channels lined by normal lymphatic endothelium.

Vascular tumors are best treated with surgical excision. Small lesions may be o treated with the flashlamp-pumped pulsed dye laser. Pyogenic granuloma and glo-mus tumors may respond to curettage and electrodesiccation or cryotherapy.

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How To Reduce Acne Scarring

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