Verrucous hemangioma

A 13-year-old female presented complaining of swelling of the skin and purplish red papules and nodules on her left leg. These lesions had been present from early childhood and had slowly enlarged, increased in number, and become more verrucous. At the age of 8 years, one of the nodules had been excised by laser, but recurrence was noted within a few months. There was occasional pain and bleeding from the lesion. Physical examination revealed a group of several well-circumscribed, hyperkeratotic, blue-red, vascular plaques arranged linearly along the inside aspect of her left lower extremity, ranging in size from 0.5 to 4.0 cm in diameter (Fig. 1). Smaller, discrete satellite nodules with a similar appearance were noted in the vicinity. Histopathologic examination showed hyperproliferation and hyperkeratosis of the epidermis. The superficial dermis showed multiple, thin-walled, dilated blood-filled spaces (Fig. 2). Similar spaces were present in the lower dermis and subcutaneous tissue. A diagnosis of verrucous hemangioma was made.