Dermatoscopy of Vascular Lesions

Vincenzo Piccolo, MDa,*, Teresa Russo, MDa, Elvira Moscarella, MDa, Gabriella Brancaccio, MDa, Roberto Alfano, MDb, Giuseppe Argenziano, MD, PhDa

KEYWORDS Dermatoscopy Dermoscopy Vascular lesions Angioma Hemangioma Kaposi sarcoma

KEY POINTS The correct identification of vascular lesions through dermoscopy is important in avoiding useless excisions and ruling out aggressive malignant tumors. With dermoscopy, most vascular lesions exhibit lacunae; that is, well-demarcated, variably colored areas, corresponding to the vascular proliferation of the lesions. When no specific dermoscopic features are detectable, biopsy is mandatory for the diagnosis to exclude malignancies.

INTRODUCTION and malignant tumors, malformations, and inflammatory diseases. The evaluation of vessels through dermoscopy This article reviews the literature concerning the plays a key role in the correct recognition of skin 1 dermoscopic features of VLs and provides an tumors, infections, and inflammatory diseases. easy, practical guide. Table 1 lists the dermo- The adequate interpretation of the shapes and dis- scopic features of the VLs described in this article. tribution of vascular structures is definitely among the most important steps in the diagnostic INFANTILE HEMANGIOMA AND CHERRY pathway. With dermoscopy, it seems obvious ANGIOMA that skin diseases that originate from cutaneous vessels are expected to show predominant Infantile hemangiomas (IHs) and cherry angiomas vascular structures that, if promptly recognized, (CAs) are benign tumors that develop from blood lead the observer to the right diagnosis. In prac- vessels; they can be considered the most com- tice, the correct identification through dermoscopy mon VTs observed in children and adults, respec- of vascular tumors (VTs) is highly important to tively. Although different in clinical presentation avoid inopportune excisions and to rule out and biological behavior, IHs and CAs are aggressive malignant tumors mimicking VTs and described together because they share common lacking specific dermoscopic features, such as dermoscopic features. Lacunae (or lagoons) are amelanotic melanoma, poorly differentiated squa- well-demarcated round or oval areas in which the mous cell carcinoma, Merkel cell carcinoma, der- color can range from red to reddish-brown or matofibrosarcoma protuberans, and primary reddish-blue, and the size can vary within the cutaneous B-cell lymphoma.2–8 lesion. Their presence is a quite constant dermo- Vascular lesions (VLs) refer to all the cutaneous scopic finding in IH and CA9,10 (Figs. 1–3). Addi- diseases that either originate from or affect ves- tional features, such as a variably colored sels, both blood and lymphatic, including benign background (red, red-blue, and red-white

Disclosure: None. a Dermatology Unit, University of Campania Luigi Vanvitelli, Via Pansini 5, Naples 80131, Italy; b Department of Anesthesiology, Surgery and Emergency, University of Campania Luigi Vanvitelli, Via Pansini 5, Naples 80131, Italy * Corresponding author. c/o II Policlinico, Edificio 9, Primo piano, Via Pansini 5, Napoli 80131, Italy. E-mail address: [email protected]

Dermatol Clin 36 (2018) 389–395 https://doi.org/10.1016/j.det.2018.05.006

Table 1 Dermoscopy features commonly seen in vascular lesions

VLs Dermoscopic Features Infantile Variably colored hemangioma lacunae and background and cherry Isolated vessels angioma Jet-black area (thrombosed hemangioma) Angiokeratoma Dark lacunae Blue-whitish veil Ulceration Rainbow pattern Fig. 1. Dermoscopy of cherry angioma showing red Pyogenic Reddish homogeneous whitish lacunae and scattered vesseIs (original magni- granuloma areas fication Â10). In the inset the clinical presentation as White rail lines red nodule of the back. White collarette Ulceration homogeneous) and isolated dilated vessels or Vessels vascular network can be found. In most cases, an- Targetoid Lacunae giomas are easily diagnosed but differential diag- hemosiderotic Ecchymotic ring nosis between thrombosed hemangioma (TH) hemangioma Peripheral network and melanoma may be challenging. With dermo- Shiny lines scopy, TH usually shows a sharply demarcated Angioma Small multiple round jet-black area corresponding to the thrombus serpiginosum to oval lacunae and associated with the classic lacunae11 (Fig. 4). Microvenular Small regular red hemangioma globules ANGIOKERATOMA Fine pigment network Port-wine stain Superficial port-wine Angiokeratomas are acquired benign vascular stain: dotted or globular proliferations histologically characterized by a vessels combination of dilated subepidermal vessels with Deep port-wine stain: epidermal acanthosis and hyperkeratosis. Angio- linear or tortuous vessels, keratoma can present as isolated or multiple, gray-whitish veil, pale blue-violaceous to black or red, 2 to 10 mm pap- circular areas ules or plaques with a scaly surface. At least 5 surrounding different types have been described, including brownish dots angiokeratoma of Mibelli, solitary angiokeratoma, Lymphangioma Variably colored lacunae angiokeratoma corporis diffusum (usually circumscriptum Vascular structures Hypopyon sign Scales Kaposi sarcoma Variably colored lacunae Rainbow pattern Scales White collarette Structureless areas Vascular structures Angiosarcoma Reddish or purple structureless areas White lines (nodular part) Pigmented Coppery-red background purpuric Round to oval dots dermatoses Gray dots Fig. 2. Dermoscopy of angioma showing blue lagoons Network (original magnification Â10). The lesion presented clinically as a bluish nodule of the face (see inset). Download English Version: https://daneshyari.com/en/article/8963657

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