Jurnal Poster B6, Hemangioma Kapiler
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CASE REPORT Capillary haemangioma in a 13-year-old boy Charles Haddad, Judella Haddad-Lacle, Fern Webb Department of Community Health and Family Medicine, University of Florida, Jacksonville, Florida, USA Correspondence to Dr Charles Haddad, [email protected] To cite: Haddad C, Haddad-Lacle J, Webb F. BMJ Case Rep Published online: [ please include Day Month Year] doi:10.1136/ bcr-2013-010495 SUMMARY This case presents a 13-year-old boy who developed an unusual skin lesion on his chest that occurred after 2–3 weeks following a traumatic injury. The lesion was raised and bled easily. It was surgically removed via shave excision and treated with electrocautery. The patient healed with no recurrence and minimal scarring. Pathology determined the skin lesion to be a capillary haemangioma. BACKGROUND Capillary haemangiomas are skin lesions that can be caused by local trauma or irritation. The factors that make this case unique are the age and sex of the patient, since these lesions are seen more commonly in pregnant women. In this case, a 13-year-old boy presented with the condition. The location of the lesion was also unusual since they are most commonly seen on the hands and face. Additionally we felt this case was important to present since it is frequently misnamed in the medical literature as ‘pyogenic granuloma’ although it is not an infection or a granuloma. CASE PRESENTATION An otherwise healthy 13-year-old white boy devel- oped a lesion on the anterior chest after receiving a blow to the chest while playing football. The patient had his jersey on although the contact site was not protected by pads. The patient reported no unusual overexposure to the sun. The lesion developed over 2–3 weeks following the injury, as reported by the patient and his caretaker, and remained approxi- mately 2 cm for about 8 weeks before the patient sought medical attention. The site would bleed spontaneously or with minimal trauma and was slightly tender ( figure 1). The patient had a shave excision performed with electrocautery treatment at the base of the lesion. The lesion healed with no recurrence and minimal scarring. Pathology was reported as an ulcerated capillary haemangioma. DIFFERENTIAL DIAGNOSIS Differential diagnoses include basal cell carcinoma, keloid scars, granulomatous reaction and cherry angiomas. Basal cell carcinoma is a tumour arising from the epidermis and is associated with sun exposure. The borders are usually pearly and the lesions do not grow as quickly as capillary haemangioma, and may become ulcerated. 1 Keloid scars are an over exuberant reaction occurring more frequently in darker skin indivi- duals and are seen especially in slow-healing wounds. Areas more susceptible to keloids include the sternum, upper arms, earlobes and cheeks. Keloids may be tender, pruritic or painful. 2 They are formed from thick collagen tissue and do not bleed spontaneously. 3 A granulomatous reaction is a giant cell reaction usually from a foreign body too large to be ingested by polymorph nuclear cells or macrophages. 4 They are firm nodules that are not friable. A cherry angioma is a non-cancerous skin growth made up of blood vessels. Cherry angiomas are bright red in colour which do not bleed easily. 5 Patients usually have more than one lesion that vary in size. While they can occur almost anywhere on the body, they usually develop on the trunk. Cherry angiomas usually do not need to be treated; however, if they bleed often or are aesthetically unattractive, they can be removed by electrocautery, cryotherapy, laser or shave excision. 5 TREATMENT Capillary haemangiomas are treated with excision and electrocautery of the base. The lesion should be completely removed and the base cauterised since small residual tissues may cause a recurrence. Smaller lesions can be treated with applications of silver nitrate or laser ablation (SORT C). 6 OUTCOME AND FOLLOW-UP The postoperative photograph ( figure 2) shows the area affected by the capillary haemangioma after excision with electrocautery. The patient’s wound healed well with minimal scarring and no recurrence. DISCUSSION The pathogenesis of capillary haemangiomas is thought to involve hormones, especially progestins since it is seen more frequently in pregnancy and in women using oral contraceptives. They are not thought to be caused by viruses. 1 The lesion Figure 1 Preoperative skin lesion, 2 cm in diameter which is raised and friable with central ulceration. Haddad C, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-010495 1 Unusual presentation of more common disease/injury
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Transcript of Jurnal Poster B6, Hemangioma Kapiler
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CASE REPORT
Capillary haemangioma in a 13-year-old boyCharles Haddad, Judella Haddad-Lacle, Fern Webb
Department of CommunityHealth and Family Medicine,University of Florida,Jacksonville, Florida, USA
Correspondence toDr Charles Haddad,[email protected]
To cite: Haddad C,Haddad-Lacle J, Webb F.BMJ Case Rep Publishedonline: [please include DayMonth Year] doi:10.1136/bcr-2013-010495
SUMMARYThis case presents a 13-year-old boy who developedan unusual skin lesion on his chest that occurred after23 weeks following a traumatic injury. The lesion wasraised and bled easily. It was surgically removed viashave excision and treated with electrocautery. Thepatient healed with no recurrence and minimal scarring.Pathology determined the skin lesion to be a capillaryhaemangioma.
BACKGROUNDCapillary haemangiomas are skin lesions that canbe caused by local trauma or irritation. The factorsthat make this case unique are the age and sexof the patient, since these lesions are seen morecommonly in pregnant women. In this case, a13-year-old boy presented with the condition. Thelocation of the lesion was also unusual since theyare most commonly seen on the hands and face.Additionally we felt this case was important topresent since it is frequently misnamed in themedical literature as pyogenic granuloma althoughit is not an infection or a granuloma.
CASE PRESENTATIONAn otherwise healthy 13-year-old white boy devel-oped a lesion on the anterior chest after receiving ablow to the chest while playing football. The patienthad his jersey on although the contact site was notprotected by pads. The patient reported no unusualoverexposure to the sun. The lesion developed over23 weeks following the injury, as reported by thepatient and his caretaker, and remained approxi-mately 2 cm for about 8 weeks before the patientsought medical attention. The site would bleedspontaneously or with minimal trauma and wasslightly tender (gure 1). The patient had a shaveexcision performed with electrocautery treatment atthe base of the lesion. The lesion healed with norecurrence and minimal scarring. Pathology wasreported as an ulcerated capillary haemangioma.
DIFFERENTIAL DIAGNOSISDifferential diagnoses include basal cell carcinoma,keloid scars, granulomatous reaction and cherryangiomas.Basal cell carcinoma is a tumour arising from the
epidermis and is associated with sun exposure. Theborders are usually pearly and the lesions do notgrow as quickly as capillary haemangioma, and maybecome ulcerated.1
Keloid scars are an over exuberant reactionoccurring more frequently in darker skin indivi-duals and are seen especially in slow-healingwounds. Areas more susceptible to keloids include
the sternum, upper arms, earlobes and cheeks.Keloids may be tender, pruritic or painful.2 Theyare formed from thick collagen tissue and do notbleed spontaneously.3
A granulomatous reaction is a giant cell reactionusually from a foreign body too large to be ingestedby polymorph nuclear cells or macrophages.4 Theyare rm nodules that are not friable.A cherry angioma is a non-cancerous skin growth
made up of blood vessels. Cherry angiomas arebright red in colour which do not bleed easily.5
Patients usually have more than one lesion thatvary in size. While they can occur almost anywhereon the body, they usually develop on the trunk.Cherry angiomas usually do not need to be treated;however, if they bleed often or are aestheticallyunattractive, they can be removed by electrocautery,cryotherapy, laser or shave excision.5
TREATMENTCapillary haemangiomas are treated with excisionand electrocautery of the base. The lesion shouldbe completely removed and the base cauterisedsince small residual tissues may cause a recurrence.Smaller lesions can be treated with applications ofsilver nitrate or laser ablation (SORT C).6
OUTCOME AND FOLLOW-UPThe postoperative photograph (gure 2) shows thearea affected by the capillary haemangioma afterexcision with electrocautery. The patients woundhealed well with minimal scarring and norecurrence.
DISCUSSIONThe pathogenesis of capillary haemangiomas isthought to involve hormones, especially progestinssince it is seen more frequently in pregnancy and inwomen using oral contraceptives. They are notthought to be caused by viruses.1 The lesion
Figure 1 Preoperative skin lesion, 2 cm in diameterwhich is raised and friable with central ulceration.
Haddad C, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-010495 1
Unusual presentation of more common disease/injury
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consists of lobular clusters of capillaries in a dense stromaaccompanied by an inammatory inltrate.1 Capillary haem-angiomas usually do not heal spontaneously and are veryfriable.1
Capillary haemangioma is a solitary, dome-shaped vascularskin lesion that frequently results from local trauma or irrita-tion. Capillary haemangioma is also known as pyogenic granu-loma and telegangiectacticum or lobular haemangioma. Theterm pyogenic granuloma is a misnomer since this is not aninfectious process or a granuloma. These are seen more fre-quently in pregnancy and childhood.7 The most frequent sitesaffected are the hands and face.This case is unique to the scientic literature because of the
age of the patient and the location of the lesion. Capillaryhaemangiomas are usually seen in younger children and preg-nant women, and most commonly on the hands and face.
Contributors The authors CH, JHL and FW contributed equally to the planning,research and writing of this article. All three accept responsibility for its content.No other persons contributed to this manuscript.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES1 Burns CA, Padgett JK, English JC. Photo quiz. Friable neoplasm during pregnancy.
Am Fam Physician 2000;62:11378. 1140.2 Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. Am
Fam Physician 2009;80:25360.3 American Academy of Family Physicians. Information from your family doctor.
Keloids: prevention and treatment. Am Fam Physician 2009;80:25368.4 Kazandjieva J, Tsankov N. Tattoos: dermatological complications. Clin Dermatol
2007;25:37582.5 Habif TP. Clinical dermatology. 5th edn. Philadelphia, PA: Mosby Elsevier, 2009.6 Ebell MH, Siwek J, Weiss BD, et al. Strength of Recommendation Taxonomy (SORT):
a patient-centered approach to grading evidence in the medical literature. Am FamPhysician 2004;69:54856.
7 Hemady N. Growing plantar lesion following trauma. Am Fam Physician2006;74:11734.
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Figure 2 Skin after excision and electrocautery of capillaryhaemangioma.
Learning points
Capillary haemangiomas are frequently caused by trauma orirritation and are thought to have a hormonal component.
Lesion consists of lobular clusters of capillaries in a densestroma accompanied by an inammatory inltrate.
Treatment includes surgical excisions, electrocautery andapplication of silver nitrate.
2 Haddad C, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-010495
Unusual presentation of more common disease/injury
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