Presenter: Robert Levine, DO, Tara Whelan, DO, Suzanne Sirota-Rozenberg, DO, FAOCD
Dermatology Program: St John’s Episcopal Hospital, Far Rockaway, NY
Program Director: Marvin Watsky, DO, FAOCD
Submitted on: August 12, 2011
CHIEF COMPLAINT: “Rash on the feet”
CLINICAL HISTORY: A 71-year-old male presented for follow up in a busy dermatology practice. He was being treated for about 6 weeks for suspected psoriasis with minimal improvement. He had mild pruritis and the rash seemed to be spreading. Previous treatments by prior physician include topical steroids (mid-high potency), topical calcipotriene, and topical antifungals. He had no other contributing skin lesions. He is of Jewish Ashkenazi descent.
PHYSICAL EXAM:
LABORATORY TESTS: N/A
DERMATOHISTOPATHOLOGY:
The superficial and deep dermal proliferation of small, angulated vessels lined by inconspicuous endothelial cells, suggestive of lymphatics. These ‘jagged’ vessels separate collagen bundles and are accompanied by a sparse infiltrate of lymphocytes and plasma cells.
DIFFERENTIAL DIAGNOSIS:
1. Angiosarcoma
2. Microvascular Hemangioma
3. Hobnail Hemangioma
4. Kaposiform Hemangioendothelioma
5. Spindle Cell Hemangioma
