Abstract

Poikilodermatous plaque-like hemangioma (PPH) is a newly described distinct entity. It is a benign acquired vascular proliferation with consistent clinical and histopathologic characteristics. Apart from the original reporting of sixteen cases, only one case report has been published in the literature. Due to the infrequency of this condition, we report an additional case of PPH. An 82-year-old man with a dermatologic history significant for psoriasis, Sjogren’s syndrome, melanoma in situ, and basal cell carcinoma presented to the clinic for a routine skin evaluation. A 3.5 cm asymptomatic, soft, erythematous, thick round plaque was noted on his right lateral lower leg. The lesion had been growing slowly for several months. A punch biopsy was obtained with suggested clinical diagnoses of cutaneous lymphoma versus psoriasis. Histopathology findings were consistent with PPH, which invariably displays a diffuse "band-like" proliferation of vessels in the papillary and reticular dermis along with epidermal changes. Given the benign nature of the lesion, the decision was made to watch and wait. It has remained indolent for over two years. PPH presents as a solitary, benign erythematous plaque on the lower extremities of older men. The clinical and histologic differential diagnosis for this solitary erythematous plaque raises suspicion for several potentially serious dermatoses, including poikilodermatous mycosis fungoides, after which PPH was named. This case and the following discussion introduce this entity, its clinical and histopathologic characteristics, and the importance of distinguishing it from its mimics in order to provide optimal care to the patient.

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