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Year : 1990  |  Volume : 56  |  Issue : 2  |  Page : 145-146

Verrucous hemangioma

MJ Cyriac, Jacob Zachariah, KR Harilal 

Correspondence Address:
M J Cyriac


A 45 years old male had a warty growth on the thigh diagnosed as verrucous hemangioma histopathologically. Earlier he had received treatment under the clinical diagnoses of verruca vulgaris and tuberculosis verrucosa cutis. The lesion was treated with surgical excision and grafting.

How to cite this article:
Cyriac M J, Zachariah J, Harilal K R. Verrucous hemangioma.Indian J Dermatol Venereol Leprol 1990;56:145-146

How to cite this URL:
Cyriac M J, Zachariah J, Harilal K R. Verrucous hemangioma. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 Jul 2 ];56:145-146
Available from: http://www.ijdvl.com/text.asp?1990/56/2/145/3509

Full Text

Verrucous hemangioma is a rare variety of angiornatous nevi usually involving the, lower extremities.[1] it has been reported under a diversity of names such as angiokeratoma circum­scriptum neviforme, unilateral ve,rrucous heman­gioma, keratotic hemangioma etc.[1],[2] Most verrucous hemangiomas appear as a solitary lesion, although rarely they can appear as a group or with satellite lesions around the main hemangioma. Lesions are present mostly at birth or appear during childhood. Initially they are sott, bluish-red vascular lesions, but with time they enlarge and develop keratotic and verrucous features.[2],[3]

 Case Report

A 45-year-old farmer was seen in January 1989 with a verrucous growth on the anterior aspect of the right thigh. He had noticed a small red patch at the site of the lesion during his childhood. The lesion had been gradually increasing in size and progressively becoming verrucous. The lesion was asymptomatic except for occasional mild pruritus. About 3 years ago, the lesion was destroyed with electro­cautery at a local hospital but recurred after two months. He was earlier given INH 300 mg daily for a period of 7 months by a physician, without any clinical improvement.

At the time of examination, the patient had a non-tender, firm, verrucous growth of 6 X 5 cm, elevated from the surrounding skin by about 0.5 cm to l cm. The lesion was not compressible and not attached to the deeper tissues [Figure 1].

The surface of the lesion was verrucous and hyperpigmented with no ulceration, bleeding or atrophy. Regional lymph nodes were not enlarged. Systemic examination was normal. Routine laboratory investigations and X-ray chest were also normal.

Biopsy of the lesion showed hyperkeratosis, parakeratosis, papillomatosis, irregular acan­thosis and presence of capillary proliferation, and cavernous spaces extending to the deep dermis. A mild to moderate infiltrate with mononuclear cells and lymphocytes was present in the dermis [Figure 2].


Verrucous hemangioma is a variant of capillary or cavernous hemangioma in which reactive epidermal acanthosis, papillomatosis and hyperkeratosis develop secondarily.[1] Loria et al[2] regarded the verrucous and hyperkeratotic changes as a reaction to injury or possibly to an altered physiological state.

Clinically the lesion is often mis-diagnosed as angiokeratoma, epidermal nevus or verruca. Although a careful history would aid in the proper diagnosis, histopathology would confirm the diagnosis.[1]

Histopathological differentiation from angio­keratoma, which it closely simulates both clini­cally and microscopically, is possible as verrucous hemangioma involves the dermis and subcuta­neous fat whereas angiokeratoma involves only the papillary dermis.[1] This differentiation is important for the management of the lesion. Complete excision and grafting is indicated in verrucous hemangioma.[4] Incomplete excision would lead to recurrence of the lesion because of the deeper components.[5]


1Imperial R and Helwig EB : Verrucous haeman­gioma, a clinicopathological study of twenty one cases, Arch Dermatol, 1967; 96 : 247-253.
2Loria PR, Derbes VJ and Krafchuk JD : Keratotic haemangioma, Arch Dermatol, 1958; 77 : 216-219.
3Atherton DJ and Rook A : Naevi and other deve­lopmental defects, in : Textbook of Dermatology, Fourth ed, Editors, Rook A, Wilkinson DS, Ebling FJG et al : Oxford University Press, Bombay, 1987; p 206.
4Mani MZ and Feierabend TC : Verrucous haeman­gioma, Report of a case treated by skin grafting, Ind j Dermatol Venereol Leprol, 1982; 48 : 116-117.
5Caro WA : Tumours of the skin, in : Dermatology, First ed, Editors, Moschella SL, Pillsbury DM and Hurley HJ : WB Saunders, Philadelphia, 1975; p 1383.


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