A recurrent case of targetoid hemosiderotic haemangioma.

181 Letters to the Editor Sir, Targetoid hemosiderotic haemangioma (THH) was first described in 1988 by Santa Cruz & Aromberg (1) as a dermatosis of a small benign vascular tumour of the superficial and mid-dermis. It is characterized by the appearance of a brown-to-violaceous central papule, surrounded by a thin, pale area and a peripheral ecchy-motic halo. It is generally accepted that THH does not resolve itself. There is no recurrence following excision, although episodic and cyclic morphological changes have been recorded (2). Since its first description, more than 158 cases have been documented, all in Caucasians (3). We report here a case of THH in China that recurred following previous spontaneous resolution. CASe reporT A 9-year-old Chinese boy presented approximately one month after the sudden appearance of an asymptomatic, violaceous papule on his left shoulder, followed by a persisting ecchymotic ring. There were no subjective symptoms. He had described a similar onset of the lesion one year previously, which had resolved completely and spontaneously within 3 months with no treatment. on examination, a 1.7-cm targetoid violaceous papule with an annular violaceous ring was noted on his upper left shoulder (Fig. 1). punch biopsy and histological evaluation revealed dilated and proliferated capillaries in the superficial dermis, with hobnail endothelial cells protruding into the lumen. The highly dilated lumens were congested with eosinophilic, homogenous materials. These blood vessels or lymphatic vessels run parallel to the surface of skin. Slit-like vessels were located in the mid-dermis and dissected between collagen bundles. extravasated erythrocytes and haemosiderin deposition were widely present in the dermis (Fig. 2 a, b). Smaller vessels were present, dissecting through collagen in the mid-dermis, with prominent dermal haemosiderin deposition (Fig. 2 c). The patient did not report any history of trauma to the pre-existing lesions in the area. All family members were Caucasian, and there were no relatives of Chinese origin. There were no systemic symptoms and the patient appeared to be in good general health. on the basis of the clinical and histological features, a diagnosis of THH was made. DISCuSSIoN THH, also known as hobnail haemangioma, is a benign, solitary, targetoid vascular neoplasm occurring predominantly on the proximal extremities and trunk, although facial locations have been recorded (1, 3). published reports of THH reveal an equal gender incidence, with an age range of presentation of 5–67 years. THH is identified more frequently in younger persons (1). Most patients …