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Targetoid hemosiderotic hemangioma
Targetoid hemosiderotic hemangioma
Other names	Hobnail hemangioma
Specialty	Dermatology

Targetoid hemosiderotic hemangioma, also known as a hobnail hemangioma is a skin condition characterized by a central brown or purplish papule that is surrounded by an ecchymotic halo.^[1]^[2] It may appear similar to melanoma. It was first described by Santa Cruz and Aronberg in 1988.^[2]

Signs and symptoms

Targetoid hemosiderotic hemangioma manifests as a single, tiny, reddish-violaceous to brown targetoid lesion that can grow centrifugally in the acute phase is encircled by a hemorrhagic halo.^[3] The halo may vanish in later phases, leaving just a central papule.^[4]^[5] There have been reports of certain cases without targetoid development.^[6] Targetoid hemosiderotic hemangioma typically develops over the trunk and extremities. The majority of these lesions have a diameter of less than 1 cm.^[7]

Causes

Although the precise etiology of targetoid hemosiderotic hemangioma is uncertain, trauma has been suggested as one of the primary causes of the targetoid look.^[8]^[9] Trauma may result in the production of microshunts, wherein the capillary pressure fills the lesion's lymph spaces with erythrocytes, hence promoting the formation of aneurysmal microstructures.^[10] There would be interstitial hemosiderin deposits, fibrosis, and inflammation if certain efferent lymphatic veins were blocked.^[10]^[11] These tumors may potentially be amplified by hormones.^[12]

Diagnosis

Red or reddish-blue lakes are clearly visible on dermoscopy, depending on how much of the dermis is involved.^[3] Hemorrhagic crusts can also be observed as black macules.^[4]

Depending on the developmental stage at which the lesion was biopsied, histology varies.^[13] There is a biphasic pattern in the early stages: in the papillary dermis, the vascular spaces are dilated and slit-like, resembling lymphatic vessels, which are concentrated around sweat glands and frequently form small hemangiomatous nodules, dissecting the collagen bundles. In the deep dermis, the vascular spaces are angulated and slit-like, resembling lymphatic vessels, with solid intraluminal projections and a hobnail appearance.^[8]^[14] There are fibrin thrombi, inflammatory lymphocytic aggregates, and extensive red blood cell extravasation.^[5]^[8]^[14] Later stages show significant hemosiderin deposition in the stroma, fibrosis, and a collapsed appearance of the arterial lumen.^[8]^[14]

Clinical differential diagnoses include infantile hemangioma, melanocytic lesions, tufted angioma, insect bite, Kaposi sarcoma, erythema multiforme, and dermatofibroma, depending on the stage of evolution. The histological differential diagnoses include epithelioid hemangioma, early Kaposi's sarcoma, progressive lymphangioma, and well-differentiated angiosarcoma.^[14]^[7]

Treatment

Simple excision is curative and enables for accurate histological diagnosis. These lesions are solely removed for diagnostic or cosmetic purposes because the condition is benign.^[3]

References

^ DE, Elder; D, Massi; RA, Scolyer; R, Willemze (2018). "Soft tissue tumours: Hobnail hemangioma". WHO Classification of Skin Tumours. Vol. 11 (4th ed.). Lyon (France): World Health Organization. pp. 347–348. ISBN 978-92-832-2440-2.
^ ^a ^b James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "28. Dermal and subcutaneous tumors". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Edinburgh: Elsevier. p. 594. ISBN 978-0-323-54753-6.
^ ^a ^b ^c Kakizaki, Priscila; Valente, Neusa Yuriko Sakai; Paiva, Daniele Loureiro Mangueira; Dantas, Fernando Luiz Teixeira; Gonçalves, Sheila Viana Castelo Branco (2014). "Targetoid hemosiderotic hemangioma - Case report". Anais Brasileiros de Dermatologia. 89 (6). FapUNIFESP (SciELO): 956–959. doi:10.1590/abd1806-4841.20143264. ISSN 0365-0596.
^ ^a ^b Sahin, M. T.; Demir, M. A.; Gunduz, K.; Ozturkcan, S.; Turel-Ermertcan, A. (2005). "Targetoid haemosiderotic haemangioma: dermoscopic monitoring of three cases and review of the literature". Clinical and Experimental Dermatology. 30 (6). Oxford University Press (OUP): 672–676. doi:10.1111/j.1365-2230.2005.01924.x. ISSN 0307-6938. PMID 16197386.
^ ^a ^b Al Dhaybi, Rola; Lam, Christina; Hatami, Afshin; Powell, Julie; McCuaig, Catherine; Kokta, Victor (2012). "Targetoid hemosiderotic hemangiomas (hobnail hemangiomas) are vascular lymphatic malformations: A study of 12 pediatric cases". Journal of the American Academy of Dermatology. 66 (1). Elsevier BV: 116–120. doi:10.1016/j.jaad.2011.05.025. ISSN 0190-9622. PMID 21798621.
^ Carlson, J.Andrew; Daulat, Soume; Goodheart, Herbert P. (1999). "Targetoid hemosiderotic hemangioma— a dynamic vascular tumor: Report of 3 cases with episodic and cyclic changes and comparison with solitary angiokeratomas". Journal of the American Academy of Dermatology. 41 (2). Elsevier BV: 215–224. doi:10.1016/s0190-9622(99)70052-6. ISSN 0190-9622. PMID 10426892.
^ ^a ^b Gutte, RameshwarM; Joshi, Abhijit (2014). "Targetoid hemosiderotic hemangioma". Indian Dermatology Online Journal. 5 (4). Medknow: 559–560. doi:10.4103/2229-5178.142579. ISSN 2229-5178. PMC 4228682. PMID 25396170.
^ ^a ^b ^c ^d Santa Cruz, Daniel J.; Aronberg, Jerome (1988). "Targetoid hemosiderotic hemangioma". Journal of the American Academy of Dermatology. 19 (3). Elsevier BV: 550–558. doi:10.1016/s0190-9622(88)70211-x. ISSN 0190-9622.
^ Christenson, Leslie J.; Stone, Mary Seabury (2001). "Trauma-Induced Simulator of Targetoid Hemosiderotic Hemangioma". The American Journal of Dermatopathology. 23 (3). Ovid Technologies (Wolters Kluwer Health): 221–223. doi:10.1097/00000372-200106000-00010. ISSN 0193-1091. PMID 11391103.
^ ^a ^b Franke, Folker E.; Steger, Klaus; Marks, Alexander; Kutzner, Heinz; Mentzel, Thomas (2004). "Hobnail hemangiomas (targetoid hemosiderotic hemangiomas) are true lymphangiomas". Journal of Cutaneous Pathology. 31 (5): 362–367. doi:10.1111/j.0303-6987.2004.00192.x. ISSN 0303-6987. PMID 15059220.
^ Trindade, Felicidade; Kutzner, Heinz; Tellechea, Óscar; Requena, Luis; Colmenero, Isabel (2012). "Hobnail hemangioma reclassified as superficial lymphatic malformation: A study of 52 cases". Journal of the American Academy of Dermatology. 66 (1). Elsevier BV: 112–115. doi:10.1016/j.jaad.2011.05.019. ISSN 0190-9622. PMID 21821311.
^ Ortiz-Rey, JA; González-Ruiz, A; Miguel, P San; Álvarez, C; Iglesias, B; Antón, I (2005-03-31). "Hobnail haemangioma associated with the menstrual cycle". Journal of the European Academy of Dermatology and Venereology. 19 (3). Wiley: 367–369. doi:10.1111/j.1468-3083.2004.01168.x. ISSN 0926-9959. PMID 15857469.
^ Guillou, Louis; Calonje, Eduardo; Speight, Paul; Rosai, Juan; Fletcher, Christopher D.M. (1999). "Hobnail Hemangioma". The American Journal of Surgical Pathology. 23 (1). Ovid Technologies (Wolters Kluwer Health): 97–105. doi:10.1097/00000478-199901000-00011. ISSN 0147-5185.
^ ^a ^b ^c ^d Mentzel, Thomas; Partanen, Taina A.; Kutzner, Heinz (1999). "Hobnail hemangioma ("targetoid hemosiderotic hemangioma"): clinicopathologic and immunohistochemical analysis of 62 cases". Journal of Cutaneous Pathology. 26 (6). Wiley: 279–286. doi:10.1111/j.1600-0560.1999.tb01845.x. ISSN 0303-6987. PMID 10472756.