Angioma serpiginosum: report of two unusual cases

Angioma serpiginosum (AS) is a rare vascular naevoid disorder due to ectatic dilation of capillaries in the papillary dermis. The condition is found almost exclusively in females who have grouped erythematous punctate lesions usually on the lower limbs or buttocks. We report two rare cases of AS, each representing a different and unusual clinical feature of AS: one with familial involvement and the other with an extensive distribution of lesions.     

匐行性血管瘤三例并文献复习

报道本院诊断的3例匐行性血管瘤(AS),并在“中国知网、PUBMED”对近20年来公开发表的关于AS的中英文文献进行回顾分析,以期提高临床医生对该疾病的认识。结果共分析122例AS患者,男女比例为1∶1.8,平均发病年龄为12.4岁,18岁前发病者占79.6%,单侧发病者占69.7%,主要表现为多个针头大小红色或紫红色斑点,散在或簇集,以匐行、环形或线形模式发展。组织病理显示表皮大致正常,真皮浅层毛细血管扩张和(或)增生,无含铁血黄素沉积、红细胞外溢及炎细胞浸润。皮肤镜显示多个边界清楚的圆形至椭圆形红色泻湖。治疗主要以血管激光为主,尤其是脉冲染料激光,显示良好的反应性。     

Acquired digital arteriovenous malformation: a report of three cases and study with epiluminescence microscopy

Acquired digital arteriovenous malformation is an abnormal connection between the arteriole and venule in the finger, fed by the digital vessels. Lesions are characterized by small, slightly raised dark-red macules on the distal part of the fingers. In the past, similar cases had been described using the terms 'cutaneous keratotic haemangioma' and 'periungual and subungual arteriovenous tumours'. In this article, we would like to discuss three additional cases that were studied using epiluminescence microscopy. Pathological findings and the possible pathogenesis are also presented.     

Angioma serpiginosum with linear distribution: case report and review of the literature

BACKGROUND: Angioma serpiginosum is a vascular anomaly that classically presents in childhood and predominantly affects females. OBJECTIVE: To present a case of a young woman with linear distribution of angioma serpiginosum and review the common clinical characteristics and presentation of this condition. METHODS: Case report with skin biopsies and dermoscopic findings. RESULTS: A clinical examination revealed numerous irregular punctate red macules in a linear distribution over the right arm. On dermoscopy, the lesions appeared as multiple sharply demarcated red lagoons. The histopathologic findings of dilated blood vessels in the papillary dermis with absence of other changes confirmed the diagnosis of angioma serpiginosum. CONCLUSION: Angioma serpiginosum is a rare entity that can be distinguished by clinical and histopathologic examinations. Lack of recognition of this condition may lead to unnecessary investigations and delayed treatment.     

Angioma serpiginosum arranged in a systematized segmental pattern suggesting mosaicism

In a 15-year-old Taiwanese girl, multiple purple punctate lesions arranged in a systematized, segmental pattern had developed since childhood, beginning from the right thigh and gradually progressing upwards to the right buttock, the left side of the abdomen, circumventing to the left side of the back, and extending to the right arm as well as to the posterolateral aspect of the left leg. Histopathological examination showed dilated capillaries in the uppermost part of the dermal papillae characteristic of angioma serpiginosum. The systematized, segmental and asymmetric arrangement of lesions as noted in the present case suggest that angioma serpiginosum reflects genetic mosaicism.     

Case report: teledermatology and epiluminescence microscopy for the diagnosis of scabies

We wish to share images from a patient seen in our teledermatology program. Due to the absence of on-site dermatology services at the Togus, Maine, Department of Veterans Affairs, and associated community clinics for veterans in Aroostook, Bangor, Calais, and Rumford, we created a program to provide dermatologic expertise from Providence, Rhode Island. Patients referred for this service were evaluated by a nurse practitioner, who obtained a history, performed a physical examination, and captured digital images of the affected area of skin, including epiluminescence microscopic images where indicated. These data were then retrieved at the Providence (host) site and reviewed by a dermatologist, who formulated an impression and plan that was then implemented by the remote site in Maine. This approach, which involves image capture at the remote site and later review of images at the host site, is the "store-and-forward" method, which appears to be a relatively cost-effective means of providing this service from a distance.     

Angioma serpiginosum: dermoscopy for diagnosis, pulsed dye laser for treatment

Angioma serpiginosum is a rare benign vascular disorder, characterized clinically by multiple minute, red to purple, grouped macules in serpiginous and gyrate patterns and histopathologically by ectatic dilatation of capillaries. Patients can undergo unnecessary hematological tests, because the condition can be confused with chronic purpuric dermatoses. An 18-year-old man with angioma serpiginosum of his left arm was evaluated by dermoscopy and treated with pulsed dye laser. Numerous small, relatively well-demarcated, round to oval red lagoons were determined with dermoscopy, and approximately 75% of the area of his lesion disappeared after four sessions of pulsed dye laser. Our case supports the hypothesis that dermoscopy is beneficial in the diagnosis of angioma serpiginosum and that pulsed dye laser is effective in the treatment of this disorder.     

Cutaneous endometriosis: non-invasive analysis by epiluminescence microscopy

The clinical appearance of cutaneous endometriosis can share some features with malignant melanoma, thus representing a possible cause for concern in both patient and clinician. In recent years, the use of epiluminescence microscopy (ELM, dermoscopy) has proved useful in improving the accuracy of diagnosis of pigmented skin lesions. The purpose of this study was to analyse the dermoscopic features of cutaneous endometriosis with histopathological correlation. We studied a case which showed homogeneous reddish pigmentation, regularly distributed. Within this typical pigmentation there were small red globular structures, but more defined and of a deeper hue, which we called 'red atolls'. ELM thus revealed a distinctive pattern in cutaneous endometriosis.     

Digital epiluminescence microscopy monitoring of high-risk patients

OBJECTIVE: To examine the outcome of digital epiluminescence microscopic (DELM) surveillance of atypical nevi in a high-risk population for 4 years. DESIGN: Atypical, flat melanocytic lesions in 100 patients at high risk of developing melanoma were followed annually with DELM. Pigmentary changes or an increase in DELM diameter of 1 mm or greater was an indication to perform an excisional biopsy. SETTING: Cardinal Bernardin Cancer Center Melanoma Program, Loyola University Health System, Maywood. PATIENTS: A consecutive sample of 3482 lesions from 100 patients (aged 18-65 years) with at least 2 images of the same lesion. MAIN OUTCOME MEASURES: The DELM change was confirmed by histopathologic examination. Patient confidence in and comfort with dermatologic surveillance and skin self-examination performance were assessed. RESULTS: During annual surveillance with DELM, 5.5% of the lesions changed. Among the 193 excisional biopsy specimens there were 4 melanomas in situ, 169 dysplastic nevi, and 20 common nevi. Confidence in and comfort with surveillance and skin self-examination improved after DELM. CONCLUSIONS: The criteria applied to detect substantial DELM changes were an increase in DELM diameter of 1 mm or greater and pigmentary changes, including radial streaming, focal enlargement, peripheral black dots, and "clumping" within the irregular pigment network. Use of DELM enhanced confidence in and comfort with care, which extended to performing more extensive skin self-examination.     

匐行性血管瘤2例

报道2例匐行性血管瘤。2例均有典型的临床表现,其中1例皮损泛发,累及躯干和四肢,另1例皮损局限于双侧臀部。1例的组织病理检查符合匐行性血管瘤的改变。经可调的脉冲染料激光治疗后,2例均取得满意的疗效。     

A statistical analysis of the characteristics of pigmented skin lesions using epiluminescence microscopy

Due to the fact that not all pigmented skin lesions (PSL) can be diagnosed solely by their clinical appearance, additional criteria are required to optimize the clinical diagnosis of atypical nevus and melanoma. Epiluminescence microscopy is a non-invasive in vivo examination that often helps to improve the accuracy of clinical diagnosis of such lesions. Years of experience have indicated some differential epiluminescent patterns for benign and malignant PSL but there is some controversy about certain borderline lesions for which histological examination is always necessary. In our study we performed a statistical analysis of data concerning 183 PSL to determine characteristics significantly associated with these lesions allowing identification of epiluminescent criteria suggestive of atypical nevus and malignant melanoma. Using the chi-quadro test and stepwise regression logistic model, we identified the following epiluminescent pattern as a risk factor for atypical nevus and malignant melanoma: irregular pigment network, presence of capillaries, irregular and abrupt ending of overall pigmentation, irregular brown globules and irregular shape and size of black dots.     

Structural analysis of melanocytic pigment nevi using epiluminescence microscopy. Review and personal experiences

Epiluminescent microscopy is now used frequently for the differential diagnosis of pigmented skin lesions. In order to improve the distinction between benign and malignant melanocytic tumours it seemed advisable to develop a standardized pathway of epiluminescent microscopical analysis and to determine the frequency of structures recognizable with the microscope. A total of 600 melanocytic lesions were examined by epiluminescent microscopy, photographed and classified histologically after excision, revealing 426 naevocellular naevi and 174 melanoma. The experience achieved during the course of the investigation was used as the basis of a procedure for stepwise analysis of keratin layer, pigment structures and blood vessels. The most important findings are described and referred to malignancy. The photographs were analysed for the frequency of occurrence of various pigment structures in different types of lesions. The results differ in several aspects from previous findings.