Unusual presentation of more common disease/injury

CASE REPORT

Capillary haemangioma in a 13-year-old boy

Charles Haddad, Judella Haddad-Lacle, Fern Webb
Department of Community
Health and Family Medicine,
University of Florida,
Jacksonville, Florida, USA
Correspondence to
Dr Charles Haddad,
chaddad2@bellsouth.net

SUMMARY
This case presents a 13-year-old boy who developed
an unusual skin lesion on his chest that occurred after
23 weeks following a traumatic injury. The lesion was
raised and bled easily. It was surgically removed via
shave excision and treated with electrocautery. The
patient healed with no recurrence and minimal scarring.
Pathology determined the skin lesion to be a capillary
haemangioma.

BACKGROUND
Capillary haemangiomas are skin lesions that can
be caused by local trauma or irritation. The factors
that make this case unique are the age and sex
of the patient, since these lesions are seen more
commonly in pregnant women. In this case, a
13-year-old boy presented with the condition. The
location of the lesion was also unusual since they
are most commonly seen on the hands and face.
Additionally we felt this case was important to
present since it is frequently misnamed in the
medical literature as pyogenic granuloma although
it is not an infection or a granuloma.

CASE PRESENTATION
An otherwise healthy 13-year-old white boy developed a lesion on the anterior chest after receiving a
blow to the chest while playing football. The patient
had his jersey on although the contact site was not
protected by pads. The patient reported no unusual
overexposure to the sun. The lesion developed over
23 weeks following the injury, as reported by the
patient and his caretaker, and remained approximately 2 cm for about 8 weeks before the patient
sought medical attention. The site would bleed
spontaneously or with minimal trauma and was
slightly tender (gure 1). The patient had a shave
excision performed with electrocautery treatment at
the base of the lesion. The lesion healed with no
recurrence and minimal scarring. Pathology was
reported as an ulcerated capillary haemangioma.

the sternum, upper arms, earlobes and cheeks.

Keloids may be tender, pruritic or painful.2 They
are formed from thick collagen tissue and do not
bleed spontaneously.3
A granulomatous reaction is a giant cell reaction
usually from a foreign body too large to be ingested
by polymorph nuclear cells or macrophages.4 They
are rm nodules that are not friable.
A cherry angioma is a non-cancerous skin growth
made up of blood vessels. Cherry angiomas are
bright red in colour which do not bleed easily.5
Patients usually have more than one lesion that
vary in size. While they can occur almost anywhere
on the body, they usually develop on the trunk.
Cherry angiomas usually do not need to be treated;
however, if they bleed often or are aesthetically
unattractive, they can be removed by electrocautery,
cryotherapy, laser or shave excision.5

TREATMENT
Capillary haemangiomas are treated with excision
and electrocautery of the base. The lesion should
be completely removed and the base cauterised
since small residual tissues may cause a recurrence.
Smaller lesions can be treated with applications of
silver nitrate or laser ablation (SORT C).6

OUTCOME AND FOLLOW-UP

The postoperative photograph (gure 2) shows the
area affected by the capillary haemangioma after
excision with electrocautery. The patients wound
healed well with minimal scarring and no
recurrence.

DISCUSSION
The pathogenesis of capillary haemangiomas is
thought to involve hormones, especially progestins
since it is seen more frequently in pregnancy and in
women using oral contraceptives. They are not
thought to be caused by viruses.1 The lesion

DIFFERENTIAL DIAGNOSIS

To cite: Haddad C,
Haddad-Lacle J, Webb F.
BMJ Case Rep Published
online: [ please include Day
Month Year] doi:10.1136/
bcr-2013-010495

Differential diagnoses include basal cell carcinoma,

keloid scars, granulomatous reaction and cherry
angiomas.
Basal cell carcinoma is a tumour arising from the
epidermis and is associated with sun exposure. The
borders are usually pearly and the lesions do not
grow as quickly as capillary haemangioma, and may
become ulcerated.1
Keloid scars are an over exuberant reaction
occurring more frequently in darker skin individuals and are seen especially in slow-healing
wounds. Areas more susceptible to keloids include

Haddad C, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-010495

Figure 1 Preoperative skin lesion, 2 cm in diameter

which is raised and friable with central ulceration.
1

Unusual presentation of more common disease/injury

Learning points
Capillary haemangiomas are frequently caused by trauma or
irritation and are thought to have a hormonal component.
Lesion consists of lobular clusters of capillaries in a dense
stroma accompanied by an inammatory inltrate.
Treatment includes surgical excisions, electrocautery and
application of silver nitrate.

Figure 2 Skin after excision and electrocautery of capillary

haemangioma.

Contributors The authors CH, JHL and FW contributed equally to the planning,
research and writing of this article. All three accept responsibility for its content.
No other persons contributed to this manuscript.
Competing interests None.
Patient consent Obtained.

consists of lobular clusters of capillaries in a dense stroma

accompanied by an inammatory inltrate.1 Capillary haemangiomas usually do not heal spontaneously and are very
friable.1
Capillary haemangioma is a solitary, dome-shaped vascular
skin lesion that frequently results from local trauma or irritation. Capillary haemangioma is also known as pyogenic granuloma and telegangiectacticum or lobular haemangioma. The
term pyogenic granuloma is a misnomer since this is not an
infectious process or a granuloma. These are seen more frequently in pregnancy and childhood.7 The most frequent sites
affected are the hands and face.
This case is unique to the scientic literature because of the
age of the patient and the location of the lesion. Capillary
haemangiomas are usually seen in younger children and pregnant women, and most commonly on the hands and face.

Provenance and peer review Not commissioned; externally peer reviewed.

REFERENCES
1
2
3
4
5
6

Burns CA, Padgett JK, English JC. Photo quiz. Friable neoplasm during pregnancy.
Am Fam Physician 2000;62:11378. 1140.
Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. Am
Fam Physician 2009;80:25360.
American Academy of Family Physicians. Information from your family doctor.
Keloids: prevention and treatment. Am Fam Physician 2009;80:25368.
Kazandjieva J, Tsankov N. Tattoos: dermatological complications. Clin Dermatol
2007;25:37582.
Habif TP. Clinical dermatology. 5th edn. Philadelphia, PA: Mosby Elsevier, 2009.
Ebell MH, Siwek J, Weiss BD, et al. Strength of Recommendation Taxonomy (SORT):
a patient-centered approach to grading evidence in the medical literature. Am Fam
Physician 2004;69:54856.
Hemady N. Growing plantar lesion following trauma. Am Fam Physician
2006;74:11734.

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Haddad C, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-010495

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