Track: Case Reports

Abstract:

Hobnail or targetoid hemosiderotic hemangioma (THH) is a rare benign vascular tumor that typically presenting as a solitary targetoid lesion. It usually begins as a small violaceous papule that gradually develops a peripheral ecchymotic ring, expanding over time. Due to its clinical resemblance to more serious conditions such as angiosarcoma and Kaposi sarcoma, misdiagnosis is not uncommon. We report a rare atypical presentation of THH in a young male who exhibited multiple progressive lesions over a three-year duration. The lesions located on the neck and scalp, where characterized by their tendency to bleed easily and were surrounded by large ecchymotic patches. Clinical examination revealed multiple violaceous papules and plaques with surrounding bruise-like discoloration. Histopathological examination from a punch biopsy confirmed the diagnosis of hobnail hemangioma. While THH generally presents as single lesion on the trunk or extremities, this case illustrates an uncommon presentation with multiple lesions and extensive ecchymosis in an unusual anatomical distribution. Such atypical cases are infrequently reported in the literature and may lead to diagnostic confusion with malignant vascular tumors. Awarness of these rare variants is crucial to ensure accurate diagnosis and avoid unnecessary aggressive treatments.

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Israa Al Hashmi