Dermoscopy and Confocal Microscopy of Thrombosed Hemangiomas

Abstract

O N CLINICAL EXAMINATION, THROMBOSED hemangiomas (THs) are sometimes difficult to differentiate from melanoma. The Figure, A and C, shows the worrisome clinical presentation of 2 cases appearing as irregularly pigmented nodules of recent onset, located on the right leg of a 48-year-old woman (Figure, A and B) and on the back of a 28-year-old woman (Figure, C and D). Dermoscopy showed a sharply demarcated, uniform, jet-black area (Figure, B and D), corresponding to the thrombus and red (Figure, B) to blue (Figure, D) lagoons, which led to the diagnosis of TH. In vivo reflectance confocal microscopy (RCM) documentation of vascular changes in skin tumors has been shown to be an important aspect of the microscopic evaluation. In our cases, RCM showed focal disruption and scaling of the cornified layer (Figure, E) and numerous dilated dark spaces (Figure, G and H [asterisks]), which were large in diameter and separated by thin fibrous septa (Figure, G and H [arrows]), corresponding to ectatic vessels below the dermoepidermal junction (Figure, F and I). Highly refractile round structures corresponding to blood cells can be visualized at higher magnification (Figure, J [arrowheads]). Blood flow was visible during in vivo imaging within the dark spaces (Video, http://www.archdermatol .com). The dilated dark spaces seen on RCM examination nicely correlated with the lagoons seen on dermoscopy, thus strongly supporting the final diagnosis of THs in both cases.