Skin nonmelanocytic tumor
Vascular tumors
Hemangioma variants
Acquired elastotic hemangioma
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Last author update: 20 September 2024
Last staff update: 20 September 2024
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PubMed Search: Acquired elastotic hemangioma
Table of Contents
Definition / general | Essential features | Terminology | ICD coding | Epidemiology | Sites | Pathophysiology | Etiology | Clinical features | Diagnosis | Prognostic factors | Case reports | Treatment | Clinical images | Microscopic (histologic) description | Microscopic (histologic) images | Virtual slides | Positive stains | Negative stains | Videos | Sample pathology report | Differential diagnosis | Board review style question #1 | Board review style answer #1Cite this page: Milani D, Kucharik A, Chen WS. Acquired elastotic hemangioma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skinnonmelanocystictumoracquiredelastotichemangioma.html. Accessed April 2nd, 2025.
Definition / general
- Rare, benign vascular tumor that affects sun exposed areas of middle aged or elderly individuals
- Characterized by a solitary red patch or plaque (J Am Acad Dermatol 2002;47:371)
Essential features
- Distinctive, benign variant of hemangioma that presents as an erythematous macule, patch, papule or plaque on sun exposed areas of middle aged and elderly individuals
- Most commonly located on the dorsal forearms
- Histopathologic examination
- Band-like capillary proliferation involving the dermis
- Usually arranged horizontally parallel to the epidermis
- Background of solar elastosis (J Am Acad Dermatol 2002;47:371)
- Strongly associated with chronic ultraviolet exposure
Terminology
- Hemangioma
ICD coding
Epidemiology
- Occurs in middle aged to elderly individuals
- Slightly more common in women (J Am Acad Dermatol 2002;47:371)
- Strong association with long term sun exposure (J Am Acad Dermatol 2002;47:371)
Sites
- Typically found on sun exposed areas (Patterson: Weedon’s Skin Pathology, 5th Edition, 2020)
- Most common: dorsal forearms
- Less common: lateral aspects of the neck
Pathophysiology
- Leading hypothesis is that ultraviolet radiation plays a role in pathogenesis
Etiology
- Thought to be caused by long term sun exposure, supported by the presence of intense solar elastosis in the involved dermis (J Am Acad Dermatol 2002;47:371)
Clinical features
- Slow growing, irregularly shaped yet well demarcated erythematous macule, papule, patch or plaque (Cureus 2017;9:e1994)
- Typically solitary but multiple lesions have been reported (Am J Dermatopathol 2022;44:437)
- Range in color from pink to red to purple
- Usually asymptomatic (Cureus 2017;9:e1994)
- Typically present for years before evaluation or diagnosis
- Predominantly located on sun exposed areas (J Am Acad Dermatol 2002;47:371)
Diagnosis
- Primarily based on histopathological examination
Prognostic factors
- Favorable prognosis; there are no reports of recurrence following surgical excision (An Bras Dermatol 2018;93:559)
Case reports
- 51 year old woman with an asymptomatic, erythematous plaque below the clavicle (Am J Dermatopathol 2020;42:244)
- 65 year old man with an asymptomatic, slow growing erythematous lesion on his forearm and dorsal hand (An Bras Dermatol 2018;93:559)
- 69 year old man with 12 reddish purple, asymptomatic plaques on the dorsal forearm (Am J Dermatopathol 2022;44:437)
- 6 patients with a clinicopathologic variant of cutaneous hemangioma (J Am Acad Dermatol 2002;47:371)
- 14 patients with acquired elastotic hemangioma (J Cutan Pathol 2010;37:460)
Treatment
- Surgical excision for symptomatic lesions or for cosmetic reasons
- Vascular laser treatment has reportedly been successful (Dermatol Surg 2018;44:136)
Clinical images
Images hosted on other servers:
Solitary erythematous plaque on hand
Erythematous macule on forearm
Erythematous papule on posterior calf
Erythematous plaque on wrist
Microscopic (histologic) description
- Broad, band-like proliferation of capillary sized blood vessels arranged horizontally along the superficial dermis, parallel to the epidermis, with prominent associated solar elastosis (Patterson: Weedon’s Skin Pathology, 5th Edition, 2020)
- Lacks atypia, mitotic figures, infiltrative growth pattern, deep extension (J Am Acad Dermatol 2002;47:371)
Microscopic (histologic) images
Contributed by Wei-Shen Chen, M.D., Ph.D.
Vascular proliferation
Capillary proliferation
CD31 stain for vascular proliferation
D2-40 negative
Virtual slides
Images hosted on other servers:
Plaque-like proliferation of capillaries within marked solar elastosis
Vascular proliferation highlighted by CD31
Positive stains
- CD34: vessels are strongly positive (Patterson: Weedon’s Skin Pathology, 5th Edition, 2020)
- CD31: vessels are strongly positive (Patterson: Weedon’s Skin Pathology, 5th Edition, 2020)
- D2-40: results of positive staining have varied
Negative stains
- Ki67 (Cureus 2017;9:e1994)
- MPM2 (Cureus 2017;9:e1994)
Videos
Acquired elastotic hemangioma
by Dr. Jerad Gardner
Sample pathology report
- Skin, right upper forearm, shave:
- Acquired elastotic hemangioma (see comment)
- Comment: Sections show a band-like proliferation of capillary vessels involving the superficial dermis, arranged parallel to the epidermis, with a background of marked solar elastosis.
Differential diagnosis
- Cherry angioma (J Am Acad Dermatol 2002;47:371):
- Clinically appear as small papules (not plaques) in both sun protected and sun exposed areas
- Lobules of capillary sized vessels with single layered endothelial cells, not necessarily in background of solar elastosis
- Acquired tufted hemangioma (J Am Acad Dermatol 2002;47:371):
- Usually a solitary, ill defined, mottled macule or plaque in children and young adults
- Lobules of capillary sized vessels with cannonball or glomerular appearing spindle shaped cells in dermis and subcutaneous fat
- Hobnail hemangioma (targetoid hemosiderotic hemangioma) (J Am Acad Dermatol 2002;47:371):
- Solitary annular, erythematous or violaceous papule surrounded by pale or dark ring (targetoid)
- Dilated superficial thin walled vessels lined by endothelial cells with hobnail nuclei protruding into vascular lumen
- Underlying smaller dissecting vessels
- Hemosiderin
- Early Kaposi sarcoma (J Am Acad Dermatol 2002;47:371):
- Erythematous to violaceous macules, patches, papules or plaques
- Jagged vascular spaces lined by thin endothelial cells, some of which exhibit the promontory sign
- Positive for HHV8 by immunostaining
- Acroangiodermatitis (of Mali) / pseudo-Kaposi sarcoma (J Am Acad Dermatol 2002;47:371):
- Erythematous to violaceous macules, patches, papules or plaques
- Usually a sequelae of chronic venous stasis
- Dermal proliferation of capillaries, fibrosis with spindle cells, red blood cell extravasation
Board review style question #1
Which of the following is true regarding the variant of hemangioma shown above?
- Clinically, these lesions present as small (< 4 mm) red papules that are not easily compressible
- Commonly found in adolescents and young adults
- Immunohistochemical staining will reveal that the endothelial cells of the lesion are strongly positive for CD31 and CD34
- Immunohistochemical staining with HHV8 (also referred to as LANA1) is positive in nearly all cases
Board review style answer #1
C. Immunohistochemical staining will reveal that the endothelial cells of the lesion are strongly positive for CD31 and CD34. The presence of a band-like capillary proliferation located in the superficial dermis, parallel to the epidermis, with a background of intense solar elastosis, is consistent with a diagnosis of acquired elastotic hemangioma. This is a benign variant of hemangioma that occurs in middle aged and elderly individuals and is thought to be caused by ultraviolet radiation. It presents as vascular patches or plaques on sun exposed areas, most commonly the forearms (Am J Dermatopathol 2020;42:244).
Answer B is incorrect because acquired elastotic hemangioma occurs most commonly in middle aged and elderly individuals, not adolescents and young adults. The median age for acquired elastotic hemangioma has been reported to be between 60 and 70 years (Cureus 2017;9:e1994). Answer D is incorrect because this describes Kaposi sarcoma, a condition that should be considered in the histopathologic differential diagnosis of acquired elastotic hemangioma. However, in contrast to the well developed, horizontally arranged capillaries seen in acquired elastotic hemangioma, Kaposi sarcoma is characterized on histopathologic examination by jagged vascular spaces lined by thin endothelial cells and the presence of inflammatory cells. Answer A is incorrect because this describes cherry angioma. In contrast to the well defined, erythematous papules that are characteristic of cherry angiomas, acquired elastotic hemangiomas present as slow growing, irregularly shaped yet well demarcated erythematous macules, papules, patches or plaques. On histopathological examination, cherry angiomas consist of dilated capillary blood vessels with variably thickened walls in the superficial dermis. Fully developed lesions may have a polypoid appearance. Furthermore, cherry angiomas are not associated with solar elastosis.
Comment Here
Reference: Acquired elastotic hemangioma
Answer B is incorrect because acquired elastotic hemangioma occurs most commonly in middle aged and elderly individuals, not adolescents and young adults. The median age for acquired elastotic hemangioma has been reported to be between 60 and 70 years (Cureus 2017;9:e1994). Answer D is incorrect because this describes Kaposi sarcoma, a condition that should be considered in the histopathologic differential diagnosis of acquired elastotic hemangioma. However, in contrast to the well developed, horizontally arranged capillaries seen in acquired elastotic hemangioma, Kaposi sarcoma is characterized on histopathologic examination by jagged vascular spaces lined by thin endothelial cells and the presence of inflammatory cells. Answer A is incorrect because this describes cherry angioma. In contrast to the well defined, erythematous papules that are characteristic of cherry angiomas, acquired elastotic hemangiomas present as slow growing, irregularly shaped yet well demarcated erythematous macules, papules, patches or plaques. On histopathological examination, cherry angiomas consist of dilated capillary blood vessels with variably thickened walls in the superficial dermis. Fully developed lesions may have a polypoid appearance. Furthermore, cherry angiomas are not associated with solar elastosis.
Comment Here
Reference: Acquired elastotic hemangioma
