Tufted angioma of the finger: A case of an uncommon location with unique dermoscopic features

Tufted Angioma of the Index Finger Middle Phalanx

A tufted angioma is a benign vascular tumor of the skin and subcutaneous tissue that classically presents as a violaceous nodule on the trunk or extremities in early childhood. Tufted angiomas of the finger are uncommon, and intraosseous involvement of these tumors is exceedingly rare. When present in the bone, these lesions may be difficult to distinguish from the more common pediatric condition of osteomyelitis or osteoid osteoma. We present the clinical, radiographic, and histopathologic findings for a unique case of a tufted angioma with intraosseous involvement in the middle phalanx treated by surgical excision and curettage with preservation of function.

Dermoscopic Analysis of Vascular Malformations and Tumors Based Upon Dominant Vascular Dermoscopic Features: A Retrospective Analysis From a Tertiary Care Center of East India

Background

Cutaneous vascular malformations and tumors comprise a vast group of conditions with variable clinical presentations. It is imperative to differentiate them from nonvascular lesions and from each other as their management and prognosis differ significantly. There is only sparse literature on dermoscopic features of various vascular malformations and tumors, especially from India.

Aim

We aimed to retrospectively study the dermoscopic findings of various vascular malformations and tumors based on their dominant vascular dermoscopic feature.

Method

All the vascular malformations and tumors for which clinical details and clinical and dermoscopic images were available were included in the analysis. The dominant vascular feature(s) was defined as a single or combination of two or more vascular features (in case a single vascular feature does not satisfy the criteria) that constitute more than 75% of the lesions’ vascular features. These included red, purple, blue, black (or any combination) dots, globules, lacunae, structureless area, linear, linear irregular, hairpin, comma, and arborizing vessels.

Results

A total of 52 patients with 68 vascular lesions (22 vascular malformations and 46 vascular tumors) were analyzed. Port-wine stain showed linear irregular vessels with sharp border with or without intervening white structureless area; unilateral nevoid telangiectasia had red dots and globules; angiokeratoma displayed red, reddish-purple to brown lacunae; blue color was seen in venous and glomuvenous malformation and venous lake; a mixed pattern was noted in infantile hemangioma and verrucous hemangioma; a red to reddish-white structureless area was observed in pyogenic granuloma and cherry angioma, and a subungual ill-defined pink structureless area was spotted in subungual glomus tumor.

Conclusion

The dermoscopic features observed in various vascular lesions may overlap; however, the dominant dermoscopic feature along with its color may point to the diagnosis.

Imiquimod 5% Cream for an Annular Plaque with Progressive Pain on the Right Distal Arm in the Cubital Fossa: Acquired Tufted Angioma

Tufted angioma, also known as angioblastoma, is a rare benign vascular neoplasm of the skin and subcutaneous tissue. The natural history of tufted angioma is slow, progressive growth for several years, and tends to remain stable thereafter, resulting in disfiguring appearance. The main choice of treatment for tufted angioma is complete surgical excision, but local recurrence is frequent. Here, we report a 33-year-old woman with a four-year history of a steadily increasing pink to violaceous plaque on her right arm accompanied by spontaneous, progressive pain over the last seven months. Histology revealed multiple separated lobules of spindle cells throughout the dermis and subcutaneous tissue to the deep margin, with numerous mitoses but no cellular atypia, the small capillary-sized vessels scattered within the lobules, which were consistent with tufted angioma. To our satisfaction, her pain disappeared and the whole plaque was significantly improved after a four-month course of external application with imiquimod 5% cream.