Verrucous malformations: their presentation and management

Verrucous hemangiomas are a distinct subset of vascular malformations that have not been described extensively in the plastic surgery literature. They are characterized by reactive epidermal acanthosis, papillomatosis, hyperkeratosis, and extension into the subcutaneous tissues. In response to injury, infection, or subtotal resection, they enlarge and become increasingly keratotic. In light of contemporary definitions of hemangiomas and malformations, the authors recommended that these lesions be renamed verrucous malformations. The authors review their evaluation and treatment of 6 patients with this lesion and offer an algorithm that emphasizes excision over ablative therapy. Of the 6 patients, 3 patients had failed either cryotherapy or laser removal by a nonsurgeon, with a consequent increase in lesion size and discomfort. The lesions were all subsequently excised. Because of the size and location of the verrucous malformations, staged removal was required in 3 patients. Patients have been followed for as long as 7 years. A single recurrence was controlled with reexcision. Excision of verrucous malformations, rather than laser ablation or cryosurgery, is supported by the authors' favorable results.