Many different and confusing terms have been used to describe vascular
lesions. Mulliken and Glowacki’s classification based on endothelial
characteristics, helps in diagnosis, planning, management and predicting the
course of these lesions. This classification has three major categories:
• haernangiomas: show endothelial hyperplasia;
• malformations: have normal endothelial turnover;
• ectasias: have normal endothelial turnover, but also have vascular
dilatation.
Haemangioma
(Fig. 13.25)
These are the most common turnouts of infancy and have a typical
history. The baby is normal at birth and at the age of 1—3 weeks is noted to
have a red mark. This increases rapidly for some weeks or even up to 3 months,
until the typical ‘strawberry’ or raspberry-like swelling is present.
Clinically, the sign of emptying may be demonstrable. The lesion is composed of
immature vasoformative tissue. The subcutaneous tissue as well as the skin is
often involved, and
Kasabach—Merritt
syndrome occurs owing to platelet trapping within the lesions. Congestive
cardiac failure with multiple cutaneous haemangiomas or large visceral haemangiomas
results from dilated vessels and arteriovenous shunting. Skeletal distortion
and cosmetic deformities in the form of telangectasias, hypopigmentation and
contour abnormalities have been observed. The final result (Fig.
13.27) is
better if natural involution is allowed to occur rather than if an attempt is
made to hasten regression by any operative or physical methods. Many
interventions are possible and should be considered only in special
circumstances. Intralesional and oral steroids have been demonstrated to
produce
These are structural and morphological anomalies due to faulty
embryological morphogenesis. The lesions are present at birth, grow commensurate
with the child and do nor regress. They can lead to underlying soft tissue or
bony hypertrophy, nodular development and discoloration as a consequence of
blood vessel ectasia with age. The natural history of these lesions is
determined by their haemodynamic and Iymphodynamic characteristics.
• High-flow lesions include arterial malformations and arteriovenous
malformations (arterial plexiform angiomas, cirsoid aneurysm).
• Low-flow lesions include lymphatic (LM) venous (VM) and capillary (CM
— port-wine stain). Frequently these lesions combine arterial, venous and
lymphatic elements.
Port-wine
stains
Port-wine stains (Fig. 13.28) are intradermal capillary malformations
that change very little throughout life, although the colour may alter a little
and they may become nodular in some areas. Treatment is for reason of
appearance. Treatment of choice for these lesions is the use of the pulsed
tunable dye laser.
Glomus
tumours
Ectasias
These represent acquired lesions such as telangectasias (spider naevus).
Lesions on the lower extremities are venular (thread veins); however, facial
telangiectasia is mostly due to arteriolar vasodilatation. Lower extremity
lesions respond to either microsclerotherapy or laser photocoagulation. Those on
the face can be treated by photothermolysis using a pulsed dye laser.
Miscellaneous
vascular lesions
Pyogenic
granuloma
Pyogenic granulomas (Fig. 13.29) are common acquired, reactive,
proliferative vascular lesions of the skin and mucous membranes, arising after
minor trauma. The lesion looks like a haemangioma, but has a typical natural
history. Usually single, it consists of a red, soft or moderately firm, more or
less pedunculated nodule that grows rapidly to a size varying from 0.5 to
2.0 cm in diameter. Most commonly it is seen on the face, the fingers and toes.
Treatment is excision.
Macular
stains
Macular stains (salmon patch, also called ‘stork bites’; not to be
confused with the ‘patch’ in syphilis) are present at birth over the
forehead in the midline, and over the occipit. They disappear by the age of 1
year and so may represent a physiological process rather than a pathological
lesion.