Successful surgical treatment of verrucous hemangioma: a combined approach

Verrucous hemangioma, also known as angiokeratoma circumscriptum naeviforme, is a rare congenital vascular abnormality. Episodes of bleeding and infection following trauma or scratching are frequent. Superficial ablative therapies using laser, cryotherapy, and electrocautery are always followed by recurrence.

To report the clinical and histopathologic characteristics and treatment results of verrucous hemangioma.

This study included 23 patients with verrucous hemangioma treated by en toto surgical excision in combination with laser therapy. Palpation, inspection, computed tomography (CT), or magnetic resonance imaging (MRI) was performed to delineate surgical margins.

The clinical presentation of verrucous hemangioma ranged from a small solitary verrucous plaque or cluster of lesions with unilateral limb involvement to Klippel-Trenaunay syndrome with bone hypertrophy. Histologically all specimens revealed the existence of hemangioma-like components in the subcutaneous tissue and dilated subepidermal blood cysts. The 14 patients presenting with small, localized lesions were cured by one session of surgery without recurrence, while the 9 patients with wider and more extensive lesions required combination therapy in several stages for optimal results.

Surgical excision in combination with laser therapy is the preferred treatment for verrucous hemangioma because the crucial pathologic change is concentrated in the subcutaneous tissue. The use of clinical inspection, palpation, and imaging studies before surgery is helpful in delineating the underlying mass.