Targetoid hemosiderotic hemangioma: one tumor, different clinical presentations

A 26-year-old patient was referred to the Dermatology Department with hypopigmented, growing tumor on the anterior aspect of the left thigh due to suspicion of cutaneous melanoma. According to the patient, the lesion had been present for approximately 10 years, but started to grow during the previous 3 years and was dynamically changing its appearance from purple tumor to brownish plaque. The patient was generally healthy and personal/family history of cutaneous neoplasia was negative. At the time of examination, clinical and dermoscopic presentation was unspecific (figs. 1 A, B), but self-taken pictures provided by the patient documenting clinical evolution of the tumor allowed for presumptive diagnosis of targetoid hemosiderotic hemangioma, which was later confirmed by histopathological examination (figs. 1 C–E).
Targetoid hemosiderotic hemangioma (hobnail hemangioma – THH) is a rare, vascular lesion that most commonly occurs on the limbs or trunk in young adults [1–4]. The cause of the disease remains unknown, nevertheless trauma is mentioned among possible precipitating factors [1–4]. The condition is limited to the skin, with no known co-morbidities [1–3]. In relation to its rapid changes in clinical presentation, some studies suggested an association with the menstrual cycle and pregnancy, but this observation was not confirmed by precise pathogenetic explanation [3, 4].
Due to its rarity and evolving clinical presentation, diagnosis may sometimes be challenging. In differential diagnosis benign and malignant skin tumors should be considered, including hemangioma, angiokeratoma, dermatofibroma, melanocytic nevus, Kaposi’s sarcoma and amelanotic melanoma [1–5]. Clinical photographs provided by the patient may facilitate the diagnosis. Dermoscopic presentation of THH differs according to the evolution phase. The most common pattern is the presence of centrally distributed red and/or dark (i.e. dark violaceous, blue-black, or black) lacunae and a peripheral red brownish homogeneous area (with or without intermediate flesh-, white-, or yellow-colored circular area). The second most common one is reddish-, violaceous or reddish-brown structureless pattern, which was observed in the described patient [6].
The treatment of choice is surgical excision with histopathological examination, which provides a good esthetic effect and is associated with low recurrence rates [1–5].

Conflict of interest

The authors declare no conflict...


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