DP13 A case of poikilodermatous plaque-like haemangioma: a newly described entity

Abstract

Abstract A 56-year-old man was referred with a 1.5 cm × 1.5 cm asymptomatic erythematous and scaly plaque on his right upper calf of 6 months’ duration. He had no similar lesions or prior skin issues. He had no significant comorbidities and was on no regular medications. There was no known family history of relevance. The initial clinical findings were felt to be in keeping with Bowen disease. He was treated once with cryotherapy, followed by two cycles of 5-fluorouracil cream, applied once daily over 4 weeks. Despite this, the plaque persisted and increased in size, measuring 3 cm × 2.5 cm. A 4-mm incisional biopsy was performed. Histopathology findings showed an acanthotic epidermis with compact hyperkeratosis, overlying a superficial dermal vascular lesion that consisted of a distinctive band-like proliferation of small endothelial cell-lined vessels. Background fibrosis and oedema were noted, as well as loss of elastic fibres within the lesional area, demonstrated by elastic van Gieson stain. Positive immunohistochemistry staining included CD31 and erythroblast transformation-specific-related gene stains, helping to confirm this lesion’s vascular origin, with a negative result for D2-40 (podoplanin), suggesting no lymphatic involvement. The histological appearances were thought to fit with a diagnosis of poikilodermatous plaque-like haemangioma (PPLH), a newly described entity of acquired vascular proliferation. Poikilodermatous plaque-like haemangioma, first described in 2019, usually presents as a solitary atrophic erythematous-to-violaceous plaque typically found in the lower limbs (Semkova K, Carr R, Grainger M et al. Poikilodermatous plaque-like hemangioma: case series of a newly defined entity. J Am Acad Dermatol 2019; 81:1257–70). Reassuringly, it has a benign course, but it can be persistent (Semkova et al.). Our patient was keen for treatment as the lesion was continuing to grow, causing him concern. However, there is sparse information available in the literature regarding effective treatments for PPLH. The case was discussed at the departmental clinicopathological meeting. The plaque was felt to be too superficial to merit any radiological investigation of the soft tissues. Surgical excision was discussed but given the size and location would most likely require a large skin graft. Sclerotherapy was considered but not felt to be appropriate in this setting. A trial of laser therapy was regarded as the best option given the superficial nature of this vascular lesion. He has since started a course of pulsed dye laser (PDL) at a wavelength of 585 nm, and we wait with interest to determine if it is effective. We therefore present this case to raise awareness of PPLH as a newly described entity and to consider it in the differential of a solitary atrophic erythematous plaque on a sun-protected site.