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June 1996

Unilateral Keratotic Vascular Lesion on the Leg

Author Affiliations

University of California, San Diego, Medical Center (Drs Wong and Hunt), and the University of Pittsburgh School of Medicine in Pennsylvania (Drs Inserra and Abell)

Arch Dermatol. 1996;132(6):708. doi:10.1001/archderm.1996.03890300137022

REPORT OF A CASE  A 63-year-old man presented with violaceous, brown plaques on his lower left leg. The plaques had been present since birth and over time had enlarged, becoming keratotic and verrucous. Minor trauma would result in ulceration, bleeding, and scale crust. Physical examination revealed a patchy, variably scaly and papillomatous lesion extending from the dorsum of the foot to the anterior midtibial surface (Figure 1).A biopsy specimen of the lesion is shown in Figure 2 through Figure 4.What is your diagnosis?

DIAGNOSIS:  Verrucous hemangioma.

HISTOPATHOLOGIC FINDINGS  The skin showed hyperkeratosis, papillomatosis, and occasional mild acanthosis overlying an angiomatous proliferation that stretched across the upper dermis and extended deep into the reticular dermis (Figures 3 and 4) and subcutaneous tissue. Focal areas of ulceration and hemorrhagic scale crust were present. The hemangioma was composed of capillary and small cavernous blood vessels.

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