epithelioid hemangioma; angiolymphoid hyperplasia with eosinophilia

Epidemiology

• uncommon
• more frequent in women than men
• median age of onset = 30 years, range: 20-50 years

Pathology

• benign neoplasm
• generally located in the dermis or subcutaneous tissue
• less commonly located in deep soft tissues
• blood vessels in periphery well formed. less so in center of lesion
• projections into the vascular lumen
• neoplastic blood vessels accompanied by variable inflammatory infiltrate of lymphocytes, eosinophils, mast cells & plasma cells

Clinical manifestations

• isolated or grouped papules, plaques, or nodules
• occurs in the skin of the head & neck, most commonly in the periauricular skin, forehead, & scalp
• isolated lesion 0.5-2.0 cm in diameter (80%)
• pruritus, pain, bleeding common

Laboratory

• complete blood count (CBC): eosinophilia

Differential diagnosis

• Kimura's disease

Management

• spontaneous resolution is rare
• medical therapy not curative
  • intralesional injections of
    • glucocorticoids
    • interferon alfa-2b
  • topical treatment with imiquimod or tacrolimus
  • systemic glucocorticoids, isotretinoin, or mepolizumab
• surgical options
  • laser therapy
  • cryosurgery
  • electrosurgery
  • Mohs micrographic surgery

More general terms

• hemangioma (strawberry nevus)