Benign vascular tumours and naevi

Contributed by Dr Jean Watkins, a sessional GP in Hampshire.

Pyogenic granuloma
The cause of this relatively common problem is unknown, but in some cases the patient will recall previous minor injury. This patient had pricked her finger when pruning a berberis bush in her garden.

About a month later she noticed a small red spot at the tip of her finger that rapidly increased to a large red, friable papule that bled when knocked.

Pyogenic granuloma

The lesions are common on the fingers but they also appear on the head, neck and upper trunk. This may occur at any age but is rare in young infants. It is said that they are seen in 5 per cent of pregnancies, and so may be influenced by hormones.

Solitary glomus tumour
A glomus tumour is a benign, vascular tumour that occurs most commonly on the hands, particularly the palms and under the nails. The lesion presents as a red or flesh-coloured, painful papule or nodule.

Solitary glomus tumour

This woman had first noticed a small spot about a year previously. It had gradually increased in size and she complained that it throbbed so much at night that it kept her awake. Treatment is by excision, which, unless complete, is likely to be followed by a recurrence.

Cherry angioma
These common benign lesions tend to develop after middle age, affect both men and women, all races and may be seen anywhere on the body. They present as bright, cherry-red papules or macules.

Cherry angioma

Treatment is not necessary, but some patients will request removal for cosmetic reasons or if the lesion becomes inflamed, infected or bleeds. This can be achieved by shave excision, curettage and cautery or cryotherapy. The cause is unknown but it seems that the appearance of more widespread multiple angiomata may occasionally be associated with an underlying internal malignancy.

Infantile haemangioma
Infantile haemangioma (strawberry naevus) is commonly seen in babies and is due to a benign overgrowth of blood vessels in the skin.

Infantile haemangioma

It appears soon after birth and rapidly grows up to 18 months of age.

After this there is gradual regression of the lesion and in half the children involution will be complete by the age of five years and most by the age of 10.

The lesion is sharply demarcated, bright red or purple and may be dome-shaped or lobulated. The majority occur in the regions of the head and neck.

Management of pyogenic granuloma
Depending of the size and position of the lesion, treatment is by curettage and cautery. Possible treatments are silver nitrate, laser therapy or cryotherapy, if the lesion is small. However, recurrences are common unless the lesion is adequately removed with complete excision.

Management of pyogenic granuloma

In this case, a good result was achieved by curettage and cautery. Histology confirmed the diagnosis.

Angiokeratoma of the genitalia
This patient had noticed a crop of purple/red spots on his scrotum. He had not previously sought help as they seemed to cause him no problem. However, there had been a little bleeding from the spots in the last few days, so he consulted. On examination the spots had a slightly rough, scaly surface. He was reassured that these lesions are harmless, occurring most commonly over the age of 40.

Angiokeratoma of the genitalia

The lesions can be ignored unless they are causing problems. The only concern is for widespread angiokeratomas which occur in a rare, inherited disorder, Fabry syndrome.

Port wine naevus
Port wine naevus occurs in 0.3 per cent of newborn babies. Present at birth, it is seen as a well-defined patch of purple or dark red skin in an area limited to one side of the body. It often occurs on the face but may occur anywhere on the body. They persist and might become more unsightly and bumpy with time. The results of treatment have improved with the advent of laser therapy.

Port wine naevus

Complications may be associated with port wine staining affecting the area of the trigeminal nerve. Underlying structures such as the brain and the eye can be affected (Sturge-Weber syndrome).

Complications of infantile haemangioma
Infantile haemangiomas rarely cause problems and can normally be left to clear on their own. In this case the haemangioma had rubbed, ulcerated and bled slightly before crusting over. Even so, the recommendation was to leave well alone, but to reduce the risk of further trauma or secondary infection by protecting the lesion with a dressing.

Complications of infantile haemangioma

The main problems arise in those lesions that may interfere with vital structures such as the eye, auditory canal or airway. Possible treatments include laser therapy, corticosteroids, interferon or imiquimod.

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