Skin nonmelanocytic tumor

• Rapidly growing, benign vascular lesion that frequently ulcerates and bleeds and is often located on sites of frequent trauma like the face, lips, mucosa and fingers
• Histopathologic features include lobules containing numerous capillary sized vessels in the dermis within an edematous stroma in early lesions or fibrotic stroma with fibrous septa in older lesions; secondary changes, such as a mixed cell inflammatory infiltrate, ulceration and granulation tissue formation, are common
• Treatment usually involves shave removal with electrodesiccation or surgical excision; may recur following treatment

• Most cases occur without an apparent cause
• Some cases are associated with recent trauma
• Higher incidence is noted during pregnancy and with the use of oral contraceptives, suggesting a possible hormonal influence
• Reference: Plast Reconstr Surg Glob Open 2024;12:e6160

• 15 year old boy with exophytic papule on the lower lip (Dent Traumatol 2020;36:446)
• 33 year old pregnant woman with bleeding intranasal lesion (Maedica (Bucur) 2024;19:160)
• 36 year old woman with bright red papule on the thumb (Dermatol Ther 2022;35:e15194)
• 40 year old man with exophytic mass on the thumb (J Surg Case Rep 2023;2023:rjad157)
• 45 year old woman with friable pedunculated papule on the upper lip (N Engl J Med 2022;387:1979)

• Shave removal followed by electrodesiccation or electrocautery is often sufficient, especially for smaller lesions
• Complete excision
• Other less common treatments include silver nitrate and laser therapy
• Reference: Plast Reconstr Surg Glob Open 2024;12:e6160

Contributed by Jason B. Lee, M.D.

Contributed by Jason B. Lee, M.D.

A 30 year old woman presents with a bleeding papule on the right hand for 2 weeks duration. A shave biopsy of the lesion is performed. Based on the histopathologic images above, what is the diagnosis?

1. Bacillary angiomatosis
2. Granulation tissue
3. Lobular capillary hemangioma
4. Pyogenic granuloma-like Kaposi sarcoma
5. Ulcerated cherry angioma

C. Lobular capillary hemangioma. The base of the lesion shows lobules of capillary sized vessels of a lobular capillary hemangioma. Answer B is incorrect because the surface of the lobular capillary hemangioma is ulcerated and granulation tissue is present below the ulcer; however, toward the base of the specimen are capillary sized vessels of a lobular capillary hemangioma. Answer A is incorrect because basophilic aggregates of bacteria are not present. Answer E is incorrect because the capillary sized caliber vessels toward the base of the lesion are too small for a cherry hemangioma. Answer D is incorrect because spindled endothelial cells with intervening erythrocytes are not present.

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Reference: Lobular capillary hemangioma

Which of the following is an important distinguishing feature of a lobular capillary hemangioma (pyogenic granuloma)?

1. Capillary sized vessels
2. Extravasated erythrocytes
3. Hyaline globules
4. Large caliber vessels
5. Presence of basophilic granular material

A. Capillary sized vessels. The vessels of a lobular capillary hemangioma are small, numerous and typically in multiple lobules. Answer B is incorrect because many vascular proliferations have extravasated erythrocytes and therefore this is not a feature used to distinguish between various vascular entities. Answer C is incorrect because hyaline globules may be seen in other vascular lesions (such as Kaposi sarcoma) but are not characteristic of lobular capillary hemangiomas. Answer E is incorrect because basophilic granular material is seen in bacillary angiomatosis, which can mimic lobular capillary hemangioma both clinically and histopathologically.  .

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Reference: Lobular capillary hemangioma