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October 2006

Purpuric Nodule on the Shoulder—Diagnosis

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Arch Dermatol. 2006;142(10):1351-1356. doi:10.1001/archderm.142.10.1351-h

Histopathologic analysis showed a poorly circumscribed dermal proliferation of irregularly shaped vessels with hobnailed endothelial cells dissecting through the collagen. Fibrosis, red blood cell extravasation, and hemosiderin deposition were present. The lesion was completely excised and had not recurred 1 year later.

Targetoid hemosiderotic hemangioma is a benign solitary vascular tumor.1 It presents as a violaceous papule or nodule with a transient ecchymotic halo on the trunk or extremities. The peripheral ring expands and disappears over time. This cyclic targetoid appearance may be attributable to repetitive trauma or hormonal fluxes.2,3 Targetoid hemosiderotic hemangioma occurs in young or middle-aged adults, with no sex predilection.2,4 The pathogenesis is unknown, but a familial predilection or common environmental exposure may be involved.5

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