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Tufted Angioma Workup

  • Author: Mitchel P Goldman, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Aug 17, 2015

Laboratory Studies

No specific laboratory study is useful in the diagnosis or treatment of tufted angioma. Urinary levels of basic fibroblast growth factor are of no value in the diagnosis of this condition, unlike juvenile capillary angioma.

If the coexistence of Kasabach-Merritt syndrome is suspected, a CBC count with a determination of the platelet count, prothrombin time and/or activated partial thromboplastin time, and full disseminated intravascular coagulation profile is indicated.


Imaging Studies

MRI studies have been proven useful in the examination of patients with deep and/or extensive tufted angiomas. MRI has been successful in evaluating the depth of invasion and extent of growth of tufted angiomas that extend deep into the muscle and fascia.[16]


Other Tests

No other tests are recommended for tufted angioma.



Other than biopsy for diagnosis and the surgical treatment described below, no other procedures are indicated for tufted angioma.


Histologic Findings

Tufted angiomas have a specific histologic pattern. They are characterized by the lobular arrangement of densely cellular capillaries, which appear similar to cannonballs, that are distributed throughout the dermis.[24] The vascular tufts consist of tightly packed hypertrophic endothelial cells with scanty cytoplasm and nuclei that are round, ovoid, or fusiform.

Mitoses are abundant, but atypia and pleomorphism are rare. Occasionally, hemosiderin deposits may be observed within the endothelial cells. Capillary spaces are narrow and elongated, and they are more noticeable in the periphery of the lobules, where they have a characteristic half-moon shape.[25]

The capillary lobules are present throughout the dermis and subcutaneous tissue; the epidermis is uninvolved in most cases. Rare cases with fascial and muscular involvement are reported.[16] The surrounding appendageal structures of the dermis are unaffected, although hypertrophy of neighboring eccrine sweat glands is reported. No edema or inflammation surrounds the vascular lobules.

Contributor Information and Disclosures

Mitchel P Goldman, MD Voluntary Clinical Professor of Dermatology, University of California, San Diego, Medical Center; Dermatologist, Cosmetic Laser Dermatology

Mitchel P Goldman, MD is a member of the following medical societies: American College of Phlebology, Aerospace Medical Association, American Society of Lipo-Suction Surgery, Phi Beta Kappa, Dermatology Foundation, San Diego County Medical Society, American Academy of Cosmetic Surgery, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, California Medical Association

Disclosure: Nothing to disclose.


Leyda E Bowes, MD Cosmetic Surgery Fellow, Department of Dermatology, Cosmetic Laser Associates of San Diego County

Leyda E Bowes, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Florida Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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

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

Disclosure: Nothing to disclose.

John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; President-Elect, American College of Mohs Surgery

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery

Disclosure: Received grant/research funds from Genentech for investigator.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Carrie L Kovarik, MD Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

  1. Jones EW, Orkin M. Tufted angioma (angioblastoma). A benign progressive angioma, not to be confused with Kaposi's sarcoma or low-grade angiosarcoma. J Am Acad Dermatol. 1989 Feb. 20(2 Pt 1):214-25. [Medline].

  2. Nakagawa K. Case report of angioblastoma of the skin. Jpn J Dermatol. 1949. 59:92-4.

  3. Igarashi M, Oh-i T, Koga M. The relationship between angioblastoma (Nakagawa) and tufted angioma: report of four cases with angioblastoma and a literature-based comparison of the two conditions. J Dermatol. 2000 Aug. 27(8):537-42. [Medline].

  4. Ban M, Kamiya H, Kitajima Y. Tufted angioma of adult onset, revealing abundant eccrine glands and central regression. Dermatology. 2000. 201(1):68-70. [Medline].

  5. Dewerdt S, Callens A, Machet L, Grangeponte MC, Vaillant L, Lorette G. [Acquired tufted angioma in an adult: failure of pulsed dye laser therapy]. Ann Dermatol Venereol. 1998 Jan. 125(1):47-9. [Medline].

  6. Murakami M, Nitta Y, Ikeya T, Hara K. Two cases of angioblastoma (Nakagawa): A one-month baby and an 84-year-old man (in Japanese). Rinsho Derma (Tokyo). 1997. 39:925-9.

  7. Jang KA, Choi JH, Sung KJ, Moon KC, Koh JK. Congenital linear tufted angioma with spontaneous regression. Br J Dermatol. 1998 May. 138(5):912-3. [Medline].

  8. Ghosh SK, Bandyopadhyay D, Ghosh A, Biswas SK, Barma KD. Acquired multifocal tufted angiomas in an immunocompetent young adult. Indian J Dermatol. 2011 Jul. 56(4):412-4. [Medline]. [Full Text].

  9. Alberola FT, Betlloch I, Montero LC, Nortes IB, Martínez NL, Paz AM. Congenital tufted angioma: Case report and review of the literature. Dermatol Online J. 2010 May 15. 16(5):2. [Medline].

  10. Fukunaga M. Intravenous tufted angioma. APMIS. 2000 Apr. 108(4):287-92. [Medline].

  11. Kleinegger CL, Hammond HL, Vincent SD, Finkelstein MW. Acquired tufted angioma: a unique vascular lesion not previously reported in the oral mucosa. Br J Dermatol. 2000 Apr. 142(4):794-9. [Medline].

  12. Lam WY, Mac-Moune Lai F, Look CN, Choi PC, Allen PW. Tufted angioma with complete regression. J Cutan Pathol. 1994 Oct. 21(5):461-6. [Medline].

  13. Miyamoto T, Mihara M, Mishima E, Hagari Y, Shimao S. Acquired tufted angioma showing spontaneous regression. Br J Dermatol. 1992 Dec. 127(6):645-8. [Medline].

  14. Fujita H, Asahina A, Tamaki K. Extensive tufted angioma of the left arm in a 47-year-old woman. Clin Exp Dermatol. 2009 Oct. 34(7):e216-7. [Medline].

  15. McAleer MA, Kirby B, Sheahan K, Collins P. An erythematous patch and plaque on the shoulder--quiz case. Acquired tufted angioma (TA). Arch Dermatol. 2008 Sep. 144(9):1217-22. [Medline].

  16. Suarez SM, Pensler JM, Paller AS. Response of deep tufted angioma to interferon alfa. J Am Acad Dermatol. 1995 Jul. 33(1):124-6. [Medline].

  17. Enjolras O, Wassef M, Dosquet C, et al. [Kasabach-Merritt syndrome on a congenital tufted angioma]. Ann Dermatol Venereol. 1998 Apr. 125(4):257-60. [Medline].

  18. Swerlick RA, Cooper PH. Pyogenic granuloma (lobular capillary hemangioma) within port-wine stains. J Am Acad Dermatol. 1983 May. 8(5):627-30. [Medline].

  19. Alessi E, Bertani E, Sala F. Acquired tufted angioma. Am J Dermatopathol. 1986 Oct. 8(5):426-9. [Medline].

  20. Kim TH, Choi EH, Ahn SK, Lee SH. Vascular tumors arising in port-wine stains: two cases of pyogenic granuloma and a case of acquired tufted angioma. J Dermatol. 1999 Dec. 26(12):813-6. [Medline].

  21. Padilla RS, Orkin M, Rosai J. Acquired "tufted" angioma (progressive capillary hemangioma). A distinctive clinicopathologic entity related to lobular capillary hemangioma. Am J Dermatopathol. 1987 Aug. 9(4):292-300. [Medline].

  22. Kim YK, Kim HJ, Lee KG. Acquired tufted angioma associated with pregnancy. Clin Exp Dermatol. 1992 Nov. 17(6):458-9. [Medline].

  23. Schaffer JV, Fangman W, Bossenbroek NM, Meehan SA, Kamino H. Tufted angioma. Dermatol Online J. 2008 Oct 15. 14(10):20. [Medline].

  24. Jones EW. Dowling oration 1976. Malignant vascular tumours. Clin Exp Dermatol. 1976 Dec. 1(4):287-312. [Medline].

  25. Prieto VG, Shea CR. Selected cutaneous vascular neoplasms. A review. Dermatol Clin. 1999 Jul. 17(3):507-20, viii. [Medline].

  26. Barco D, Baselga E, Ribe A, Alomar A. [Congenital self-limiting tufted angioma]. Actas Dermosifiliogr. 2008 Jun. 99(5):423-5. [Medline].

  27. Descours H, Grézard P, Chouvet B, Labeille B. [Acquired tufted angioma in an adult]. Ann Dermatol Venereol. 1998 Jan. 125(1):44-6. [Medline].

  28. Munn SE, Jackson JE, Jones RR. Tufted haemangioma responding to high-dose systemic steroids: a case report and review of the literature. Clin Exp Dermatol. 1994 Nov. 19(6):511-4. [Medline].

  29. Bernstein EF, Kantor G, Howe N, Savit RM, Koblenzer PJ, Uitto J. Tufted angioma of the thigh. J Am Acad Dermatol. 1994 Aug. 31(2 Pt 2):307-11. [Medline].

  30. Leaute-Labreze C, Bioulac-Sage P, Labbe L, Meraud JP, Taieb A. Tufted angioma associated with platelet trapping syndrome: response to aspirin. Arch Dermatol. 1997 Sep. 133(9):1077-9. [Medline].

  31. Silva RS, Bressan AL, Nascimento LB, Kac BK, Azulay-Abulafia L. Tufted angioma and myofascial pain syndrome. An Bras Dermatol. 2011 Feb. 86(1):125-7. [Medline].

This lesion is a tufted angioma in a 1-year-old girl. Present since birth, this bluish-red hemangioma-like plaque on the patient's right upper leg slowly enlarged and became tender during the month prior to presentation. The child was otherwise well. A skin biopsy specimen revealed dilated congested capillaries in the lower dermis and subcutis. Clusters of capillaries with hyperplastic endothelial cells were also scattered in the mid and upper parts of the dermis. The epidermis revealed a slight basket-weave orthokeratosis, with minimal acanthosis, and papillomatosis. The patient was treated conservatively with only observation. The lesion remained stable and did not progressed since presentation. Courtesy of National Skin Centre, Singapore.
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