Targetoid hemosiderotic hemangioma D18.01

Rare, solitary hemangioma occurring at any age (preferably in adolescence) with a characteristic, shooting-disk-like clinical aspect.

Mostly solitary, 0.2-0.5 cm in Ø, red to brown-red papule/plaque, which in some cases (about 20%) is surrounded by a narrow pale halo and a larger brownish ring (shooting disc aspect). This halo may fade or recede with time. Spontaneous regression of the hemangioma is not uncommon. 'Target-like' hemangioma.

Shallow dark brown variants may lack cocard stratification, causing them to be misrecognized as melanocytic neoplasms.

Biphasic growth:

• Superficial dermis: dilated, lacunar, thin-walled vessels lined by prominent "hobnail" endothelia, few intraluminal erythrocytes. Erythrocyte extravasations and hemosiderin deposits are frequently present (see clinic below).
• Deep dermis: slit-like vascular spaces with hemosiderin deposits between compacted collagen bundles. Smooth muscle actin-positive pericytes are absent (indication of lymphatic differentiation). No mitoses or nuclear atypia.

Clinical: Kaposi's sarcoma; Meyerson's nevus; granuloma anulare.

Histological: Angiosarcoma; retiform angioendothelioma; malignant endovascular papillary angioendothelioma; lymphangioma, progressive.

The skin change with a characteristic cockade pattern was initially regarded as a hemosiderotic hemangioma. In fact, it is neither a hemangioma nor a proliferating tumor, but rather a superficial lymphatic malformation. In this respect, it is listed under lymphatic mal formations in the classification of vascular malformations.

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