Verrucous Hemangioma: A Mode of Presentation with Literature Review

Dr Nazan Shagufta

Abstract: The present case offers an insightful and unusual presentation of verrucous hemangioma (VH), a rare vascular anomaly that typically arises at birth and progresses with age. What makes this case compelling is the unusual keratoacanthoma - like morphology observed in a 58 - year - old male patient, whose lesion had persisted and recurred despite multiple surgical excisions over a span of five decades. Unlike the commonly reported locations such as lower extremities, this lesion manifested on the forearm and displayed a central crateriform hyperkeratotic plug, a feature rarely documented in literature. Dermoscopic examination revealed hyperkeratosis along with dark bluish - black lacunae findings that, in my view, add a novel dimension to the diagnostic criteria for VH. Histopathological analysis confirmed the diagnosis by showing deep vascular proliferation extending into the subcutis, distinguishing it from more superficial angiokeratomas. This suggests that VH may present with broader clinical variability than previously thought, emphasizing the need for histological correlation and deep biopsy to avoid misdiagnosis and ensure complete excision. Ultimately, this case enriches the clinical spectrum of VH and underscores the importance of considering it among differentials for chronic, hyperkeratotic vascular lesions.

Keywords: verrucous hemangioma, keratoacanthoma - like lesion, vascular anomaly, hyperkeratosis, dermoscopy