Angiokeratoma Circumscriptum Treatment & Management

  • Author: William P Baugh, MD; Chief Editor: William D James, MD   more...
 
Updated: Jan 13, 2012
 

Medical Care

Medical care of these superficial vascular lesions is not usually required.

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Surgical Care

  • Angiokeratoma circumscriptum lesions are asymptomatic benign vascular malformations that require no treatment. Nevertheless, surgical treatment is often rendered for cosmesis or because of clinical concern regarding the possibility of melanoma. Either ablation (after a firm diagnosis is established) or excision of the lesions (when the diagnosis is uncertain) can be performed. Depending on the size and the location of the angiokeratoma, simple excision may be the treatment of choice. Small lesions may also be treated with diathermy, curettage, and cautery.
  • Laser ablation has proven highly effective and may offer the best cosmetic outcome. Specifically, the argon laser has been reported to effectively eliminate angiokeratomas, although associated scarring and posttreatment hypopigmentation are risks.[19, 20]
    • One treatment approach is to initiate treatment with an erbium or carbon dioxide laser to remove the hyperkeratotic-acanthotic epidermis, followed by the use of a laser that targets hemoglobin, such as the flash pump dye, KTP, or 880-nm diode laser.[21, 22]
    • Alternatively, an erbium or carbon dioxide laser may be used alone, although this approach may cause significant collateral thermal damage to the dermis and, thus, significant scarring may ensue.
    • A KTP laser or 800-nm diode laser may also be used alone, although multiple procedures may be needed for adequate treatment, depending on the underlying vessel diameter and the overlying epidermal thickness. Because of its wavelength and deeper dermal penetration, the 800-nm diode laser may be most useful for blue-black angiokeratoma circumscriptum or those with thrombosed vessels.
    • The KTP laser destroys vascular targets and is relatively specific for cutaneous blood vessels; therefore, it is ideal for the treatment of cutaneous vascular lesions. It causes less purpura than other laser systems, and patients are able to return to work immediately after treatment to the face. A typical setting for a 532-nm KTP laser for trunk angiokeratomas might be a fluence of 16-20 J/cm2 with a pulse duration of 30-50 milliseconds and a spot size of 4 mm.
  • Other superficial ablative therapies, such as cryotherapy, may also be effectively used to treat superficial angiokeratomas. Recurrence of the lesion after surgical excision or ablation should bring into question the original diagnosis, and histopathologic examination of the lesions should be incorporated into the evaluation of the process in such an event.
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Consultations

Consult a dermatologist for both diagnostic and therapeutic suggestions. Submit all biopsy specimens to a dermatopathologist.

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Contributor Information and Disclosures
Author

William P Baugh, MD  Assistant Clinical Professor of Dermatology, University of California Irvine School of Medicine and Western School of Medicine; Medical Director, Full Spectrum Dermatology; Consulting Staff, Department of Dermatology, St Jude Medical Center

William P Baugh, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Laser Medicine and Surgery, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Coauthor(s)

Cynthia L Chen  Western University of Health Sciences College of Osteopathic Medicine of the Pacific

Cynthia L Chen is a member of the following medical societies: American Osteopathic Association, American Osteopathic College of Dermatology, California Medical Association, and Los Angeles County Medical Association

Disclosure: Nothing to disclose.

Terry L Barrett, MD  Clinical Professor of Dermatology and Pathology, University of Texas Southwestern School of Medicine; Director, ProPath Dermatopathology, Dallas, Texas

Terry L Barrett, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, College of American Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Timothy McCalmont, MD  Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Apsara Consulting fee Independent contractor

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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  7. Ghosh SK, Bandyopadhyay D, Ghoshal L, Haldar S. Angiokeratoma circumscriptum naeviforme: a case report of a rare disease. Dermatol Online J. Sep 15 2011;17(9):11. [Medline].

  8. Imperial R, Helwig EB. Verrucous hemangioma. A clinicopathologic study of 21 cases. Arch Dermatol. Sep 1967;96(3):247-53. [Medline].

  9. Schiller PI, Itin PH. Angiokeratomas: an update. Dermatology. 1996;193(4):275-82. [Medline].

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  12. Yildirim M, Kilinc N, Oktay MF, Topcu I. A case of solitary angiokeratoma circumscriptum of the tongue. Kulak Burun Bogaz Ihtis Derg. 2007;17(6):333-5. [Medline].

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  16. Ilyas EN, Seykora JT, Heymann WR. Acquired agminated acral angioma: a novel vascular lesion. Arch Dermatol. May 2005;141(5):646-7. [Medline].

  17. Rossi A, Bozzi M, Barra E. Verrucous hemangioma and angiokeratoma circumscriptum: clinical and histologic differential characteristics. J Dermatol Surg Oncol. Jan 1989;15(1):88-91. [Medline].

  18. Wang G, Li C, Gao T. Verrucous hemangioma. Int J Dermatol. Oct 2004;43(10):745-6. [Medline].

  19. Occella C, Bleidl D, Rampini P, Schiazza L, Rampini E. Argon laser treatment of cutaneous multiple angiokeratomas. Dermatol Surg. Feb 1995;21(2):170-2. [Medline].

  20. Pasyk KA, Argenta LC, Schelbert EB. Angiokeratoma circumscriptum: successful treatment with the argon laser. Ann Plast Surg. Feb 1988;20(2):183-90. [Medline].

  21. Gorse SJ, James W, Murison MS. Successful treatment of angiokeratoma with potassium tritanyl phosphate laser. Br J Dermatol. Mar 2004;150(3):620-2. [Medline].

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  23. Dolph JL, Demuth RJ, Miller SH. Angiokeratoma circumscriptum of the index finger in a child. Plast Reconstr Surg. Feb 1981;67(2):221-3. [Medline].

 
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A hyperkeratotic, asymmetric, variably pigmented, black 3 X 4-mm papule was found on the upper right medial part of the arm of this 18-year-old woman, who was concerned about melanoma. The histologic analysis revealed a thrombosed angiokeratoma circumscriptum.
Close-up view of an asymmetric black angiokeratoma mimicking a melanoma.
Low-magnification histologic view reveals some hyperkeratosis and acanthosis with rete ridges surrounding dilated vascular channels in the papillary dermis.
This mid-power histologic view reveals dilated vessels in the papillary and upper reticular dermis. The vessels are packed with red blood cells; this finding is suggestive of vessel thrombosis.
This high-power histologic view reveals some hyperkeratosis and acanthosis with rete ridges surrounding dilated vascular channels in the papillary dermis. Dilated vessels in the papillary and upper reticular dermis are observed. The vessels are packed with red blood cells; this finding is suggestive of vessel thrombosis. A normal-appearing vascular endothelium is found. No evidence of a melanocytic lesion is present.
 
 
 
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