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A 69-year-old man requests treatment for a slowly enlarging growth proximal to his right eyebrow. The lesion had been present for at least a year and is asymptomatic. Examination reveals a 0.6-cm erythematous papule. No other significant skin finding is noted. A shave biopsy is performed.
Can you diagnose this condition?
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Arteriovenous hemangiomas (AVH) are acquired benign vascular lesions comprising interconnecting arterial and venous structures. These lesions result from the aberrant development of vascular elements in capillaries, arteries, and veins.1 Angiogenic factors have been isolated and play a role in AVH pathogenesis.2 AVH are compressible and do not spontaneously involute. Unlike the deeper variety that predominates in children and adolescents, superficial lesions most commonly affect middle-aged and elderly adults and are frequently found on the head and neck.3
Diagnosis is made clinically and may be aided by dermoscopy, which characteristically reveals nonarborizing telangiectasia and homogeneous pigmentation.4 Histopathology reveals arteries and veins in proximity to each other. Shave excision with cautery and laser ablation is curative.
References
- Chim H, Drolet B, Duffy K, Koshima I, Gosain AK. Vascular anomalies and lymphedema. Plast Reconstr Surg. 2010;126(2):55e-69e.
- Zhan M, Hori Y, Wada N, et al. Angiogenic factor with G-patch and FHA domain 1 (AGGF1) expression in human vascular lesions. Acta Histochem Cytochem. 2016;49(2):75-81.
- Roy S. Vascular tumours: pathology of arteriovenous hemangioma [arteriovenous malformation]. http://www.histopathology-india.net/AVH.htm. Accessed Jan 2, 2019.
- Zaballos P, Medina C, Del Pozo LJ, Gómez-Martín I, Bañuls J. Dermoscopy of arteriovenous tumour: a morphological study of 39 cases. Australas J Dermatol. 2018;59(4):e253-e257.
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