Abstract
Poikilodermatous plaque-like hemangioma (PPH) is a new entity with only 17 reported patients so far in the literature. We describe two additional cases. Case 1: An 89-year-old woman presented with a 2 cm annular pink leathery plaque on the left knee of 1 years duration which she stated felt like a brush burn. She denied any preceding trauma or rubbing. There was no improvement after several weeks of topical steroid. Subsequent biopsy was submitted with a differential diagnosis including mycosis fungoides but showed a broad band of small bland thin-walled vessels in the superficial dermis. Elastic staining revealed loss of elastic fibers within the lesion. Case 2: An 89-year-old woman presented for evaluation of an occasionally tender, annular smooth violaceous plaque on the right lateral calf of 1 years duration. There was no change with topical steroids. Telangiectases were visible on dermoscopy. The clinical differential diagnosis included fixed drug eruption and non-melanoma skin cancer. Biopsy revealed a diffuse proliferation of small, round blood vessels with a single endothelial layer and mild dermal edema. Elastic fibers were diminished in the lesion. PPH is a recently described benign vascular proliferation typically involving the lower extremities of older adults. Awareness of this entity is important for dermatopathologists as the clinical differential frequently includes mycosis fungoides. Potential histologic mimic, microvenular hemangioma, typically has a different clinical history, involving younger individuals with histology showing irregular branching vessels intercalating between dermal collagen with inconspicuous lumina in the superficial and deep dermis. Acquired elastotic hemangioma favors the sun exposed areas of the body and unlike the diminished elastic in PPH, the vessels are intermingled with numerous elastotic fibers.
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