Targetoid haemosiderotic haemangioma: dermoscopic monitoring of three cases and review of the literature

Abstract

Targetoid haemosiderotic haemangioma represents a new, rarely reported, distinctive, benign vascular tumour, characterized histopathologically by a biphasic growth pattern of dilated vascular structures in the superficial dermis lined by prominent hobnail endothelial cells and collagen dissecting, rather narrow neoplastic vessels in deeper parts of the lesion. In the initial stage, the lesion is seen as a small purple or violaceous papule, 2--3 mm in diameter. Over time, the ecchymotic ring expands peripherally until it disappears spontaneously. In the later stages, however, the central papule remains as a slightly raised dermal lesion with a purple to brownish discolouration. We report three cases whose repetitive cyclic morphological changes of targetoid haemosiderotic haemangiomas were monitored dermoscopically at 3-month follow-ups. Histopathological examination of each lesion identified the features of targetoid haemosiderotic haemangioma. To the best of our knowledge, our three cases are the first reported in the literature of targetoid haemosiderotic haemangiomas that were regularly monitored by dermoscopic examinations, enabling development of the different stages of the same lesion to be followed.

Dermoscopy of Targetoid Hemosiderotic Hemangioma: A Morphological Study of 35 Cases

“…This pattern could be identified in 71.4% of our cases and it is also the most common pattern found in the isolated cases published in the literature [3,4,5,6,7]. Lacunae are defined as multiple, clustered, well-demarcated, reddish to dark structures with a round to oval shape.…”

“…Like some authors, we consider THH a hemosiderotic lymphatic malformation [1,2] and all dermoscopic patterns as different evolutive phases of THH formation [3,6,17]. In the initial stages, a precipitating factor (traumas or hormonal factors [1,2] have been postulated) could lead to the development or expansion of micro-shunts in which the pressure of the capillaries would cause filling of the lymph spaces of the lesion with erythrocytes and contribute to the formation of aneurysmal microstructures.…”

“…Dermoscopy is a noninvasive technique that has greatly improved the accuracy of diagnoses of pigmented and nonpigmented skin tumors. To the best of our knowledge, apart from sporadic case reports [3,4,5,6,7], no studies evaluating the dermoscopy of THH have been published in the literature. We consider it worthwhile to communicate the dermoscopic features of a large series of THH in different stages that could improve its clinical diagnostic accuracy.…”

“…The classic clinical presentation of THH is a single, annular, vascular lesion with a targetoid appearance, with a brown to violaceous central papule surrounded by a thin, pale area and a peripheral ecchymotic ring [1,2]. Frequently, however, the clinical presentation of THH is nondistinctive, nontargetoid, or atypical, depending on the stage of its cyclical changes, and the differential diagnoses include infantile hemangioma, Kaposi sarcoma, insect bite reaction, dermatofibroma, melanocytic nevus, and melanoma [1,2,3,4,5,6,7]. Dermoscopy is a noninvasive technique that has greatly improved the accuracy of diagnoses of pigmented and nonpigmented skin tumors.…”

A Case of Hobnail Hemangioma

“…Klinik olarak bu lezyonlar hemanjiyom, anjiyokeratom, melanositik nevüs, melanom, dermatofibrom ve hatta insect bite reaksiyonu olarak yanlış tanı alabilir (4,11).…”