Indian Journal of Dermatology
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CASE REPORT
Year : 2009  |  Volume : 54  |  Issue : 5  |  Page : 51-52
Verrucous hemangioma treated with electrocautory


Dermatology and Pathology, Midnapore Medical College, West Bengal, India

Correspondence Address:
Arun Achar
D2-Burdge Town, Paschim Medinipur - 721 101
India
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Source of Support: None, Conflict of Interest: None


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   Abstract 

Verrucous hemangioma is a rare form of vascular malformation which is usually congenital. Most of the cases present as wart-like dark blue to erythematous papules, nodules and plaques with special predilection in lower extrimities. We are reporting here a 19-year-old Muslim patient with large Verrucous hemangioma in the left leg along with discending of right shoulder without any signs of neurological involvement. Patient was successfully treated with repeat serial Electrocautory.


Keywords: Electrocautery, hemangioma, verrucous


How to cite this article:
Achar A, Biswas SK, Maity AK, Naskar B. Verrucous hemangioma treated with electrocautory. Indian J Dermatol 2009;54, Suppl S1:51-2

How to cite this URL:
Achar A, Biswas SK, Maity AK, Naskar B. Verrucous hemangioma treated with electrocautory. Indian J Dermatol [serial online] 2009 [cited 2019 Oct 22];54, Suppl S1:51-2. Available from: http://www.e-ijd.org/text.asp?2009/54/5/51/45456



   Introduction Top


Verrucous hemangioma is a vascular malformation and may be a variant of either strawberry or cavernous hemangioma. [1] Its usual onset is at birth or beginning of childhood as a macule, which tends to grow proportionally with body development. [2],[3],[4] It usually presents as papules, plaques and nodules of bluish erythematous color with verrucous or irregular surface with unilateral distribution preferably located in lower limb. [4]

Histologically Verrucous hemangioma are characterized by increased vascularization from dermis to subcutaneous tissue and the relapse is common after the conventional treatment. [4] Recurrent bleeding and ulceration often seek the patient to take medical advice. [5]


   Case History Top


An 18-year-old Muslim male patient presented asymptamatic lesion with onset during the infancy, located at lateral aspect of left leg, and progressing in size. The lesion started as small bluish maculoplaque eruption at left leg. There were history of occasional itching and bleeding. No history of trauma or loss of weight and appetite, nor fever were detected.

Cutaneous examination revealed a large area of erythematous bluish plaque approximately 7cm 8cm, present over lateral aspect of left leg. Surface of the plaque is rough, slightly scaly and moderately verrucous. Small scaly papules present as satelite lesion at surrounding area of main lesion [Figure 1].

Elevation of the right shoulder was detected during other systemic cutaneous examination.

Hair, nail, mucous membrane were normal. Systemic examination was normal. No neurological abnormality detected.

Routine examination, X-ray chest, left leg and left foot were normal. X-ray of the right shoulder revealed cervical vertebral fusion with undiscended scapula.

Following differential diagnosis were considered - Lichen simplex, prurigo nodularis and Verrucous hemangioma .

Skin biopsy showed, hyperkeratosis, irregular acanthosis, papilomatosis and vascular proliferation of superficial dermis extending deep in the subcutaneous tissue.

Repeated serial electrocautory were done with four weeks intervals, for four times. The lesion healed with scarred hyperpigmented lesion. No history of bleeding from the sites has seen during the last one year follow-up period [Figure 2].


   Discussion Top


Verrucous hemangioma is an infrequent variety of deep-seated capillary or cavernous hemangioma with reactive epidermal hyperplasia and a superficial component indistinguisable from those of angiokeratoma. It is usually congenital lesion which don't resolve spontaneously and have a tendency to recur after excision if margins are inadequate. [6]

The lesion appears as well circumscribed erythematous bluish macules which increase in size with time, acquiring an erythematous violet color and its surface becoming verrucous and hyperkeratotic. [2] Such verrucous hyperkeratotic aspect of the lesion is considered to be a reaction of injury, such as trauma or infection. [5],[6],[7],[8] Ninety five percent of Verrucous hemangioma is located in the lower extrimities. [9]

Histopathologically, it is characterized by the presence of angiomatous proliferation with dilated vessels extending down to reticular dermis and subcutaneous tissue like our patient. [8],[10]

In our patient, we found the cervical vertebral fusion with discending scapula without signs of meningospinal involvement. These finding was not detected earlier and the cause may be unrelated. In contrast to angiokeratoma, Verrucous hemangioma does not respond well to most usual physical treatment like cryotherapy, electrocoagulation and laser therapy, presenting frequent relapse due to its extension to deeper dermis and subcutaneous tissue which require deep and wide excision. [7],[9]

For this reason, we had done the repeat superficial serial electrocautory in our patient with an intervals of four weeks. We had not seen any relapse within the one year follow-up period.

 
   References Top

1.Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF. Dermatology in general Medicine. 4th ed. New York: McGraw Hill; 1993. p. 1219.  Back to cited text no. 1    
2.Tan YY, Seah CS, Tan PH. Verrucous hemangioma : A case report. Ann Acad Med Singapore 1998;27:255-7.  Back to cited text no. 2  [PUBMED]  
3.Kawaguchi H, Kawaguchi T, Ishii N, Nakajima H, Ichiyama S. Verrucous hemangioma . Acta Derm Venereol 1997;77:405-6.  Back to cited text no. 3  [PUBMED]  
4.Alice CZ, Neftali NV. Angioma Verrucosocongenito. Rev Chil Dermatol 1996;12:158.  Back to cited text no. 4    
5.Champion RH, Burton JL, Burns DA. Text book of dermatology. 6th ed. Oxford: Blackwell Science Ltd; 1998. p. 567.  Back to cited text no. 5    
6.Puig L, Llistosella E, Moreno A, de Moragas JM. Verrucous hemangioma . J Dermatol Surg Oncol 1987;13:1089-92.  Back to cited text no. 6  [PUBMED]  
7.Wong DS, Hunt SJ, Inserra DW, Avell E. Unilateral Keratotic vascular lesion on the leg: Verrucous hemangioma . Arch Dermatol 1996;132:705-8.  Back to cited text no. 7    
8.Imperial R, Helwig EB. Verrucous hemangioma : AClinicopathologic study of 21 cases. Arch Dermatol 1967;96:247-53.  Back to cited text no. 8  [PUBMED]  
9.Calduch L, Orlega C, Novarro V, Martinez E, Molina I, Jorda E. Verrucous hemangioma : report of two cases and review of the literature. Pediatr Dermatol 2000;17:213-7.  Back to cited text no. 9    
10.Mankani MH, Defreshne CR. Verrucous malformation: Their presentation and management. Ann Plast Surg 2000;45:31-6.  Back to cited text no. 10    


    Figures

  [Figure 1], [Figure 2]



 

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    Abstract
    Introduction
    Case History
    Discussion
    References
    Article Figures

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