TUFTED ANGIOMA

By Gary M. White, MD


The tufted angioma (TA) is a rare vascular tumor of infancy.
An erythematous or red-brown often indurated plaque usually of the trunk or neck is characteristic of the TA, also known as the angioblastoma of Nakagawa.

Clinical

The typical lesion starts off as a pink macule or patch that grows into a deep read or purple indurated nodule or plaque. Rarely, it be greater than 10 cm in greatest diameter.

A significant percentage of lesions are tender and local hyperhidrosis is not uncommon. The shoulder, upper back and neck are commonly affected sites. Although onset is typically in childhood (e.g. first 5 years of life), congenital cases and onset in adulthood have been reported. Lesions usually enlarge for several years before stabilizing. Malignant transformation has yet to be reported. Some have been reported to invade the underlying fascia and muscle, causing significant soft tissue swelling. These lesions are easily confused with hemangiomas. Their dusky color, associated discomfort and continued growth after 12 to 18 months of ages are helpful distinguishing characteristics.

Kasabach-Merritt syndrome may develop in either the TA or Kaposi's hemangioendothelioma. Histopathologically, small, circumscribed, angiomatous tufts and lobules are seen in the dermis--thus the name.

Treatment

The CBC with platelets should be followed by making sure Kasabach-Merritt phenomenon does not arise. Observation of this benign lesion is recommended as it will often resolve spontaneously. Surgical excision may be done for small lesions.

Anecdotally helpful treatments have included the dye laser, the argon tunable-dye laster with Hexascan, subcutaneous interferon alfa, and intralesional injection of interferon alpha2.

References

Tufted angioma in an 18 year old. Indian Dermatol Online J 2016;7:62-3

A 2-month-old baby girl presented with a stable, asymptomatic vascular tumor, present since birth on the medial aspect of her right arm. Exam showed a soft, non-pulsatile, raised purplish plaque, measuring 4 x 2 cm, exhibiting no change in temperature, and surrounded by a pale peripheral halo. Derm Online Journal 16 (5)

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