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Erythematous Plaque on the Lower Extremity of an Older Adult Man

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

An otherwise healthy man in his early 70s presented to the Department of Dermatology with a 2-year history of a mildly pruritic, erythematous, and gradually enlarging lesion on the proximal portion of his left calf. The lesion had appeared without an identifiable cause, and for the previous 2 months, the patient had applied topical corticosteroids and antifungals with no improvement. Physical examination revealed an ill-defined, nonindurated, erythematous-violaceous plaque that was slightly raised but with an atrophic appearance (Figure, A). A skin biopsy was obtained for histopathology examination (Figure, B-D).

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A. Poikilodermatous plaque–like hemangioma

Histopathologic evaluation showed a band-like vascular proliferation in the upper dermis with no grenz zone. Vascular spaces were round and lined by a single layer of endothelial cells. No hemosiderin deposits were found with Perls Prussian blue stain. Vascular channel endothelial cells were positive for CD34 and CD31 but negative for D2-40. Based on histopathological findings, a diagnosis of poikilodermatous plaque–like hemangioma (PPH) was established. Considering the benign nature of the lesion, no treatment was performed.

Poikilodermatous plaque–like hemangioma is a newly described vascular proliferation. To our knowledge, only 17 cases of PPH have been reported. It is typically located on the lower extremity of older adult men and commonly described as a slowly growing, asymptomatic, solitary, erythematous-violaceous plaque with an overlying cigarette-paper wrinkling that gives an atrophic appearance.1,2

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Article Information

Corresponding Author: Dídac Marín-Piñero, MD, Department of Dermatology, Hospital Universitari Sagrat Cor, Grupo Quirónsalud, C/Viladomat, 288, 08029 Barcelona, Spain (marindidac@gmail.com).

Published Online: June 29, 2022. doi:10.1001/jamadermatol.2022.2492

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Semkova  K , Carr  R , Grainger  M ,  et al.  Poikilodermatous plaque-like hemangioma: case series of a newly defined entity.   J Am Acad Dermatol. 2019;81(6):1257-1270. doi:10.1016/j.jaad.2019.03.069PubMedGoogle ScholarCrossref
2.
Sullivan  M , Hartman  R , Mahalingam  M .  Poikilodermatous plaque-like hemangioma: a benign vasoformative entity with reproducible histopathologic and clinical features.   J Cutan Pathol. 2020;47(10):950-953. doi:10.1111/cup.13734PubMedGoogle ScholarCrossref
3.
Jeunon  T , Carvalho Wagnes Stöfler  ME , Teixeira Rezende  P , Staccioli Castro  M , Jeunon-Sousa  MA .  Acquired elastotic hemangioma: a case report and review of 49 previously reported cases.   Am J Dermatopathol. 2020;42(4):244-250. doi:10.1097/DAD.0000000000001479PubMedGoogle ScholarCrossref
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Martorell-Calatayud  A , Balmer  N , Sanmartín  O , Díaz-Recuero  JL , Sangueza  OP .  Definition of the features of acquired elastotic hemangioma reporting the clinical and histopathological characteristics of 14 patients.   J Cutan Pathol. 2010;37(4):460-464. doi:10.1111/j.1600-0560.2009.01361.xPubMedGoogle ScholarCrossref
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Linos  K , Csaposs  J , Carlson  JA .  Microvenular hemangioma presenting with numerous bilateral macules, patches, and plaques: a case report and review of the literature.   Am J Dermatopathol. 2013;35(1):98-101. doi:10.1097/DAD.0b013e318259944aPubMedGoogle ScholarCrossref
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Napekoski  KM , Fernandez  AP , Billings  SD .  Microvenular hemangioma: a clinicopathologic review of 13 cases.   J Cutan Pathol. 2014;41(11):816-822. doi:10.1111/cup.12386PubMedGoogle ScholarCrossref
7.
Giacaman  A , Del Pozo  LJ , Bauzá  A , Saus  C .  Microvenular hemangioma: morphological study of 3 cases.   Actas Dermosifiliogr (Engl Ed). 2018;109(4):381-384. doi:10.1016/j.ad.2017.06.015PubMedGoogle ScholarCrossref
8.
Singh  SK , Manchanda  K .  Acroangiodermatitis (pseudo-Kaposi sarcoma).   Indian Dermatol Online J. 2014;5(3):323-325. doi:10.4103/2229-5178.137791PubMedGoogle ScholarCrossref
9.
Rongioletti  F , Rebora  A .  Cutaneous reactive angiomatoses: patterns and classification of reactive vascular proliferation.   J Am Acad Dermatol. 2003;49(5):887-896. doi:10.1016/S0190-9622(03)02100-5PubMedGoogle ScholarCrossref
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