Verrucous hemangioma is a structural variant of capillary or cavernous hemangioma in which reactive epidermal acanthosis, papillomatosis, and hyperkeratosis develop secondarily. The clinical appearance of verrucous hemangioma may simulate that of angiokeratoma and the separation of the two lesions is important, since the histologic and clinical behavior are different. Verrucous hemangiomas are vascular malformations, whereas the angiokeratomas are telangiectasias, Verrucous hemangioma usually involves the lower extremities and spreads slowly. As the lesion spreads, satellite nodules may develop. Verrucous hemangioma involves the dermis and the subcutaneous fat, but angiokeratoma involves only the papillary dermis. Recurrence is frequent in verrucous hemangioma because of the involvement of the deeper tissue and possibly because of altered hemodynamics opening up preexisting noncanalized malformed vessels. Verrucous hemangioma should be excised while still small to prevent large and unsightly scars.
Imperial R, Helwig EB. Verrucous HemangiomaA Clinicopathologic Study of 21 Cases. Arch Dermatol. 1967;96(3):247-253. doi:10.1001/archderm.1967.01610030025004