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Tumors and tumor-like processes in the skin vessels: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025

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Tumor-like processes observed in skin vessels are based on embryonic dysplasias accompanied by the splitting off of angioblastic elements, which, starting from the embryonic period, proliferate and form various types of hamartomas. These include telangiectatic nevus; angiectasias of blood and lymphatic vessels of congenital or acquired nature with reactive changes in vascular foams; angiokeratomas appearing later in life in the cotton wool of reactive changes in the epidermis: angiomas - benign vascular neoplasms with proliferation of vascular elements of either a purely capillary type or with a partial arterial or venous component.
In addition, there are antiectatic malformations combined with various congenital disorders, such as diffuse phleboecasis, venous spots (spider nevus), hemorrhagic telangiectasia (Rendu-Osler disease) and Hutchinson's serping ectasia.
Telangiectatic nevus is present from birth, clinically characterized by the presence of one or more dark red or bluish-red spots, usually not protruding above the skin surface. There are two types of nevus: medially located mainly in the occipital region and neutral part of the egg and localized laterally, usually unilateral on the face and limbs. The latter is combined with congenital disorders of other organs and tissues (leptomeningeal naevus flamrneus, Sturge-Weber syndrome, Klippel-Trenaunay syndrome).
Pathomorphology. Medially located telangiectatic nevus is characterized by dilation of capillaries of the subpapillary layer of the dermis in the early period of life, whereas with lateral localization this process begins at approximately 10 years of age and concerns not only the subcapillary layer of the dermis, but also its deeper layers, including the subcutaneous tissue.
Angiokeratoma is characterized by angiomatosis accompanied by reactive changes in the epidermis (acanthosis, hyperkeratosis). WF Lever and C. Schaumhuig-Lever (1983) distinguish five types of angiokeratoma:
- generalized systemic type - diffuse angiokeratoma of Fabry, which is a hereditary disorder of metabolic processes in the body (lipidosis);
- angiokeratoma limited nevoid of the fingers of Mibelli;
- Fordyce angiokeratoma of the scrotum and vulva;
- soditarial papular angiokeratoma and
- angiokeratoma limited.
Angiokeratoma circumscriptum nevoidum of the fingers of Mibelli is clinically characterized by the presence of small (1-5 mm or more in diameter) painless dark red or cyanotic cystic nodular elements that disappear during diascopy, located symmetrically, mainly on the skin of the dorsal and lateral surfaces of the fingers of the upper and lower extremities, sometimes on the buttocks and other places. The surface of the element is hyperkeratotic, sometimes there are warty growths. The rash usually appears in puberty, more often in girls with increased sensitivity to cold, accompanied by acrocyanosis, hyperhidrosis of the palms and soles, a tendency to chills and numbness of the extremities,
Pathomorphology. In fresh elements, dilation of the capillaries of the upper part of the dermis is noted, in old foci - hyperkeratosis, acanthosis, papillomatosis. The capillaries in the dermis are sharply dilated with perivascular lymphocytic infiltration.
Angiokeratoma of the scrotum and vulva Fordyce is characterized by the presence of multiple vascular papules with a diameter of 2 to 5 mm, the size and number of which increase with age. Fresh rashes are bright red, soft consistency, while old lesions are bluish, with hyperkeratosis. They can be accompanied by itching and bleeding.
Solid papular angiokeratoma usually appears at a young age in the form of slightly elevated nodular elements measuring from 2 to 10 mm, with papular rashes along the periphery. It is localized mainly on the lower extremities. Fresh lesions are similar to those on the scrotum, old ones are bluish-black with a hyperkeratotic surface, which resembles malignant melanoma. In most cases, angiokeratomas of this type are solitary.
The pathomorphology of all the above-described varieties of angiokeratoma is similar. In fresh lesions, dilation of the capillaries of the upper dermis is observed, in old lesions - hyperkeratosis, slight acanthosis and papillomatosis, more pronounced dilation of the capillaries, around which lymphocytic infiltrates can sometimes be seen. In such cases, organizing or organized thrombi and more pronounced dilation of the capillaries in the deep parts of the dermis and subcutaneous fat layer are detected.
In the papular form of angiokeratoma, there is only expansion of the capillaries of the superficial parts of the dermis, i.e. it is essentially telangiectasia.
Angiokeratoma limited in the early stages is one or more lesions consisting of red angiomas merging with each other, with an uneven hyperkeratotic surface. Sometimes they have a linear arrangement, are localized mainly on the shins and feet, and usually exist from birth. With age, the lesions increase in size and new elements appear. Limited angiokeratoma can be combined with telangiectatic nevus and Klippel-Trenaunay syndrome.
Pathomorphology. This form is characterized by hyperkeratosis, acanthosis, and papillomatosis. Sharply dilated capillaries are located near the epidermis and are sometimes enclosed in its epidermal outgrowths. Although most vessels are filled with blood, some of them, with thin walls, contain lymph. Thrombi are sometimes found in dilated capillaries. Unlike papular angiokeratoma, in which superficial telangiectasias are observed, in limited angiokeratoma, dilation of the entire vascular network of the dermis, as well as subcutaneous tissue, is detected.
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