Skin nonmelanocytic tumor
Vascular tumors
Acquired tufted angioma

Topic Completed: 1 August 2016

Minor changes: 14 October 2020

Copyright: 2002-2020,, Inc.

PubMed Search: Acquired tufted angioma

Joel Tjarks, M.D.
Sara C. Shalin, M.D., Ph.D.
Page views in 2019: 4,205
Page views in 2020 to date: 3,431
Cite this page: Tjarks J, Shalin SC. Acquired tufted angioma. website. Accessed October 21st, 2020.
Definition / general
  • Benign, acquired vascular tumor most often arising in infancy or early childhood
  • Rare; approximately 200 cases reported in literature to date
Essential features
  • Tufts of capillaries infiltrating the dermis and subcutaneous adipose tissue in a “cannonball” or lobular pattern
  • Considered to be on the same neoplastic spectrum as kaposiform hemangioendothelioma; some consider it to be the same entity
  • Synonyms: Tufted angioma, Nakagawa’s angioblastoma, progressive capillary hemangioma, tufted hemangioma
  • Most commonly affects children and young adults with no gender predilection
  • Rare cases have been reported in adults
  • May be seen in association with Kasabach-Merritt syndrome
  • Some cases have been associated with liver transplantation, pregnancy, healed herpes zoster sites, or vaccination sites
  • Commonly found on neck, shoulders and trunk
  • Cranial and facial lesions are uncommon
Clinical features
  • Erythematous, poorly defined mottled macules and plaques typically ranging from 2 - 5 cm
  • Usually solitary
  • May have overlying hypertrichosis
  • Slowly growing, spreading lesion
  • Spontaneous regression rarely occurs; most lesions persist
Case reports
  • Surgical excision for small lesions; recurrences are common
  • Low dose aspirin
  • High dose steroids (intralesional or systemic)
  • Pulsed dye laser
  • Chemotherapy(vincristine)
Clinical images

Images hosted on PathOut servers:

Courtesy of Mark R. Wick, M.D.

Images hosted on other servers:

Subcutaneous nodule

Microscopic (histologic) description
  • Multiple, scattered lobules of small capillary type vessels with small oval to spindle shaped cells throughout the dermis and subcutaneous tissue imparting a “cannonball” or glomerular appearance
  • May have variable mitoses without nuclear atypia
  • Hemosiderin may be present; in contrast to pyogenic granuloma, inflammation is typically absent
  • In contrast to Kaposi sarcoma, no slit-like vascular spaces and no plasma cells
  • In contrast to kaposiform hemangioendothelioma, confined to skin and less infiltrative
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Drs. Manuel Valdebran and Phil LeBoit, UCSF

Courtesy of Joel Tjarks, M.D.

Images hosted on other servers:

Cannon ball distribution

Positive stains
  • CD31, CD34
  • D2-40 highlights surrounding dilated dermal lymphatics
Negative stains
Differential diagnosis
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