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Abstract

Epithelioid hemangioma (EH) is a rare, benign vascular tumor that typically presents with a solitary, slowly growing pink to reddish-brown papule or nodule on the head or neck. Diagnosis can be challenging due to its resemblance to other vascular proliferations such as Kimura disease, epithelioid hemangioendothelioma, and epithelioid angiosarcoma. A 20-year-old healthy male presented to the dermatology clinic with a three month history of three pruritic lesions of the right lower cheek. Mucocutaneous exam showed three well-defined dome-shaped 0.5-1 cm skin-colored to pink papules and nodules involving the right lower cheek. Initial differential diagnosis included keloid, hemangioma, and molluscum contagiosum. Shave biopsy showed epithelioid hemangioma. There was a circumscribed nodular proliferation consisting of small to dilated blood vessels lined by plump epithelioid cells, hemorrhage within the vascular spaces, and fibrin deposition throughout. A significant stromal eosinophilic and lymphocytic inflammatory infiltrate was also present. A Human Herpesvirus (HHV)-8 stain was negative. At follow-up six months later, he had developed 15 new papules and nodules involving the right cheek. One year after initial onset, he had 25 papules and nodules involving the right cheek. Intervention was provided with shave removal of all 25 lesions. Since clinical presentation of EH overlaps with that of malignant vascular tumors, the diagnosis of EH must be made histologically. The rapid development of numerous EH in this patient is unique. Dermatologists should be aware that EH can exhibit rapid lesion multiplication; timely, complete removal may benefit select patients.