We read with great interest the article by Knispel and Shaw1 on cutaneous ulceration as the initial presenting manifestation of a hemangioma of infancy, which appeared in the "Off-center Fold" section of the March 2001 issue of the ARCHIVES. We agree that this manifestation represents an important, albeit uncommon, clinical presentation of hemangioma of infancy. In addition to the report by Rekant and Katz2 that was cited by the authors, we reported 3 cases of perineal ulcers as the presenting manifestation of a hemangioma of infancy, as well as a fourth case with an identical presentation in the perioral area.3
Liang MG, Frieden IJ. Perineal Ulcerations as the Presenting Manifestation of Hemangioma. Arch Dermatol. 2002;138(1):126. doi:10.1001/archderm.138.1.125
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