Dermoscopy of Vascular Lesions: Hemangiomas and Angiokeratomas

Overview / Definition Hemangiomas are benign vascular tumors commonly seen in infants, characterized by a proliferation of endothelial cells. In contrast, angiokeratomas are benign vascular lesions characterized by dilated capillaries and often associated with a keratotic surface, commonly found in adults. Epidemiology Hemangiomas are among the most common tumors in infancy, affecting approximately 5-10% of infants. They are more prevalent in females, particularly in those with low birth weight. Angiokeratomas, on the other hand, are typically seen in adults and can occur in various forms, with angiokeratoma of Fordyce being the most common variant. Pathophysiology / Mechanism Hemangiomas arise from the proliferation of endothelial cells, leading to the formation of an increased number of blood vessels. The growth phase of hemangiomas is followed by involution, where the lesion gradually regresses over time. In contrast, angiokeratomas result from vascular ectasia, where small blood vessels become dilated, often leading to surface changes such as keratosis. Clinical Presentation Hemangiomas typically present as bright red, raised lesions that may vary in size. They often appear within the first few weeks of life and may undergo rapid growth before eventually fading. In contrast, angiokeratomas usually present as small, dark red or blue papules with a rough surface, often located on the lower extremities or genital areas. Diagnosis / Workup The diagnosis of hemangiomas and angiokeratomas is primarily clinical, often supported by dermoscopy. Key dermoscopic features include: Hemangiomas: Red or purple color Glomerular vessels (dilated capillaries) Surface markers (telangiectasia) Angiokeratomas: Blue-black color Keratinized surface “Red lacunae” (dilated vessels) Biopsy may be warranted in atypical cases to exclude malignancy. Treatment / Management Management of hemangiomas often involves observation, as many will involute spontaneously. However, treatment options ma