What are the other Names for this Condition? (Also known as/Synonyms)

• Angiokeratoma Circumscriptum Naeviforme
• Hemangioma Unilateralis Neviforme
• Nevus Angiokeratoticus

What is Verrucous Hemangioma? (Definition/Background Information)

• Hemangiomas are benign malformation of blood vessels that can occur in several tissues such as the brain, kidney, liver, lung, skin, and nasal cavity
• Verrucous Hemangioma (VH) is a rare and uncommon type of hemangioma that presents features of either a capillary hemangioma or a cavernous hemangioma. These hemangiomas usually have a congenital origin, but may be seen during early childhood too
• The cause for development of Verrucous Hemangioma is not yet well understood. No specific risk factors have also been identified
• Verrucous Hemangiomas typically grow to large sizes over a period of time. The skin over the lesions may rupture and bleed. With time, the skin over the lesions are known to harden and thicken (a condition called hyperkeratotis)
• While Verrucous Hemangiomas do not present any significant signs and symptoms, they may be longstanding. The treatment options include removal of the tumor through surgery
• The prognosis of Verrucous Hemangioma is good with suitable treatment. But, many are known to reappear following their removal

Who gets Verrucous Hemangioma? (Age and Sex Distribution)

• Verrucous Hemangiomas are usually present at birth, though some may be discovered during the child’s first few years (2-4 years)
• Both males and females are equally at risk
• It may be observed in individuals of all races and ethnic backgrounds across the world

What are the Risk Factors for Verrucous Hemangioma? (Predisposing Factors)

• The specific risk factors that contribute towards Verrucous Hemangioma development has not been established
• The lesion may be present as a part of Cobb syndrome (a genetic disorder)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Verrucous Hemangioma? (Etiology)

• The exact cause for development of Verrucous Hemangioma is unknown
• It is known to have a congenital origin, but presently no genetic causative factors have been recognized

What are the Signs and Symptoms of Verrucous Hemangioma?

The signs and symptoms of Verrucous Hemangioma may include the following:

• A cluster of skin lesions may be seen, mostly in the lower leg, which is the most common site of presentation
• The arrangement of this pattern may be linear or curved
• Other sites that may be involved include the arms, and rarely, the chest, back, or abdomen
• In rare cases, when the lesion is present along with a spinal defect on the back, it may be associated with Cobb syndrome
• The group of skin lesions are soft to touch and red-blue in color
• They are usually well-defined, and sometimes, may merge/coalesce to form a large solitary hemangioma
• In such cases, when a large lesion is observed, smaller-sized lesions (called satellite lesions) may be seen within the vicinity of the large hemangioma
• The skin lesions are associated with oozing, bleeding, and ulceration
• With time, the appearance and color changes; the color takes on shades of brown or blue-black
• Also, with time, the outer skin layer over the lesion thickens and becomes hard (termed hyperkeratotis) and crust formation may be seen; hyperkeratotis is a very classical feature of Verrucous Hemangioma that is observed in almost all cases
• With hyperkeratotis, the lesion may be misdiagnosed as a wart; however, Verrucous Hemangiomas are much larger in size

How is Verrucous Hemangioma Diagnosed?

A diagnosis for Verrucous Hemangioma includes evaluating the clinical history (physical exam) and a thorough family history. Other tools to help diagnose the condition may include:

• A visual assessment by the physician can help diagnose the condition
• CT and MRI scan of the affected region, if necessary
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• A differential diagnosis to rule out angiokeratoma may be undertaken

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Verrucous Hemangioma?

The complications of Verrucous Hemangioma include the following:

• Bleeding and ulceration may result in secondary bacterial or fungal infections to form
• In some individuals, it may present cosmetic (appearance) issues
• Verrucous Hemangiomas, in general, are difficult to treat
• Recurrence of the lesions are frequently observed following their removal

How is Verrucous Hemangioma Treated?

Verrucous Hemangiomas may be asymptomatic, but are progressive in their growth. These skin lesions are known to grow to large sizes and be present for many years. Also, in case of frequent bleeding or cosmetic issues related to physical appearance, individuals may choose to remove them.

Procedures for removing the hemangioma may include:

• Burning (electrosurgery/cautery)
• Freezing (cryotherapy)
• Laser excision
• Surgical excision

Note:

• Superficial/topical applications are sometimes known to worsen the condition
• Also, since the exact margins of these lesions may be difficult to establish, their complete surgical removal is often challenging. Repeat removal of the lesions through multiple surgeries may be necessitated
• In case large areas are affected and skin grafts used, the Verrucous Hemangiomas are still known to recur

How can Verrucous Hemangioma be Prevented?

Currently there are no specific methods or techniques to prevent the formation of a Verrucous Hemangioma.

What is the Prognosis of Verrucous Hemangioma? (Outcomes/Resolutions)

• Verrucous Hemangiomas are benign tumors, but may be present for several years
• The prognosis of the skin condition with adequate treatment is generally good. Nevertheless, the lesions are known to locally recur

Additional and Relevant Useful Information for Verrucous Hemangioma:

• Cavernous hemangiomas are benign growths composed of small blood vessels that occur on skin tissues, anywhere in the body, usually in children. These benign tumors can sometimes rupture and bleed if injured
• A benign capillary hemangioma is one of the most common type of hemangioma that can be either present from birth (congenital origin) or develop sometime later

The following links may help you find useful additional information on cavernous hemangioma and benign capillary hemangioma:

http://www.dovemed.com/diseases-conditions/cavernous-hemangioma/

http://www.dovemed.com/diseases-conditions/benign-capillary-hemangioma/