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A case of deep tufted angioma
862
Journal of the American Academy of Dermatology May, Part 1, 1996
Correspondence
REFERENCES 1. Paull WH, Polley D, Fitzpatrick JE. Malignant melanoma arising intradermally in a small congenital nevus of an adult. J Dermatol Surg Oncol 1986;12:1176-8. 2. Tajima Y, Nakajhna T, Sugano I, et al. Malignant melanoma within an intradermal nevus. Am J Dermatopathol 1994;16:301-6. 3. Benisch B, Peison B, Karmestein M, et al. Malignant melanoma arising from intradermal nevi. Arch Dermatol 1980; 116:696-8. 4. Okun MR, DiMattia A, Thompson J, et al. Malignant melanoma developing from intradermal nevi. Arch Dermatol 1974;110:599-601. 5. Okun MR, Banman L. Malignant melanoma arising from an intradermal nevus. Arch Dermatol 1965;92:69-72. 6. Cooper PH. Deep penetrating (plexiform spindle cell) nevus. J Cutan Pathol 1992;19:172-80. 7. Spitz S. Melanomas of childhood. Am J Pathol 1948; 24:591-609. 8. Sau P, Graham JH, Helwig EB. Pigmented spindle cell nevus: a clinicopathologic analysis of ninety-five cases. J AM ACAD DERMATOL1993;28:565-71. 9. Muhlbauer JE, Margolis RJ, Mibm MC, et al. Minimal deviation melanoma: a histologic variant of cutaneous malignant melanoma in its vertical growth phase. J Invest Dermatol 1983;80(suppl):63s-5s. 10. Torres JE, Torres SM, Sanchez JL. Melanoma in-sire on facial skin damaged by sunlight. Am J Dermatopathol 1994;16:171-4.
A case of deep tufted angioma To the Editor: We read with interest the article by Suarez, Pensler, and Paller (J AM ACAD DERMATOL 1995;33: 124-6) on the response of deep tufted angioma to interferon alfa. The authors describe extension of the lesion through subcutaneous tissue into fascia and superficial muscle. They claim that no previous examples of extension of rafted angioma into fascia or muscle have been noted. W e reported deep tufted angioma on the thigh and buttock of a 10-week-old child that with magnetic resonance imaging showed interdigitation with the superficial fibers of the ghiteus maximus. 1 W e agree, however, that such deep extension is rare because our review of 31 cases of tufted angioma revealed no other cases with extension through the subcutis. Our patient was unresponsive to interferon alfa at a dose of 2 million U/m 2 over a 6-week period. The treatment had to be discontinued because the lesion had increased from 7 x 5 c m to 9 x 6 cm; thrombocytopenia had developed and liver function tests showed abnormalities. A good response was subsequently achieved with systemic steroids. There is no consensus regarding treatment of these lesions. Pulsed dye laser has been used with good results in one case, e in addition to the successful use of an argon tunable-dye laser cited by Suarez and colleagues. Inter-
feron alfa and systemic steroids as well as laser therapy should, therefore, be considered in the treatment of this rare tumor.
S. Munn R. Russell Jones Dermatology Department Hammersmith Hospital Du Cane Road London WI2 0NN, U.K.
REFERENCES 1. Munn SE, Jackson JE, Russell Jones R. Tufted hemangioma responding to high dose systemic steroids. Clin Exp Dermatol 1994;19:511-4. 2. Frenk E, Vion B, Merot Y, et al. Tufted angioma. Dermatologica 1990;181:243-3.
Reply To the Editor: W e appreciate the letter by Drs. Munn and Russell Jones. W e regret that we did not include this report in our article, l, 2 The central portion of this tufted angioma that involved underlying muscle appeared to respond after 10 days of interferon alfa at I million U/mg. However, the periphery advanced and platelet sequestration developed after doubling of the dose for 4 weeks, a scenario reminiscent of Kasabach-Merritt syndrome and not typical of a tufted angioma. After 6 weeks of prednisone at 2 mg/kg per day, the lesion stabilized and platelet count increased. W h y this tufted angioma responded to prednisone and not to interferon alfa is unknown. Our experience with patients and the literature suggests that patients with complicated hemangiomas or Kasabach-Merritt syndrome (rapidly enlarging hemangioma with platelet sequestration), or both often respond to either systemic interferon alfa or corticosteroids. The relatively recent recognition of tufted angioma as a distinct lesion will no doubt lead to a higher number of case reports and development of clearer treatment guidelines. S. M. Suarez, MD J. Pensler, AID A. Pallet, MD Departments of Pediatrics, Dermatology, and Surgery Northwestern University Medical School Evanston, Illinois
REFERENCES 1. Munn SE, Jackson JE, Russell-Jones RR. Tufted hemangioma responding to high-dose systemic steroids: a case report and review of the literature. Clin Exp Dermatol 1994; 19:511-4.
Journal of the American Academy of Dermatology May, Part 1, 1996
Correspondence
REFERENCES 1. Paull WH, Polley D, Fitzpatrick JE. Malignant melanoma arising intradermally in a small congenital nevus of an adult. J Dermatol Surg Oncol 1986;12:1176-8. 2. Tajima Y, Nakajhna T, Sugano I, et al. Malignant melanoma within an intradermal nevus. Am J Dermatopathol 1994;16:301-6. 3. Benisch B, Peison B, Karmestein M, et al. Malignant melanoma arising from intradermal nevi. Arch Dermatol 1980; 116:696-8. 4. Okun MR, DiMattia A, Thompson J, et al. Malignant melanoma developing from intradermal nevi. Arch Dermatol 1974;110:599-601. 5. Okun MR, Banman L. Malignant melanoma arising from an intradermal nevus. Arch Dermatol 1965;92:69-72. 6. Cooper PH. Deep penetrating (plexiform spindle cell) nevus. J Cutan Pathol 1992;19:172-80. 7. Spitz S. Melanomas of childhood. Am J Pathol 1948; 24:591-609. 8. Sau P, Graham JH, Helwig EB. Pigmented spindle cell nevus: a clinicopathologic analysis of ninety-five cases. J AM ACAD DERMATOL1993;28:565-71. 9. Muhlbauer JE, Margolis RJ, Mibm MC, et al. Minimal deviation melanoma: a histologic variant of cutaneous malignant melanoma in its vertical growth phase. J Invest Dermatol 1983;80(suppl):63s-5s. 10. Torres JE, Torres SM, Sanchez JL. Melanoma in-sire on facial skin damaged by sunlight. Am J Dermatopathol 1994;16:171-4.
A case of deep tufted angioma To the Editor: We read with interest the article by Suarez, Pensler, and Paller (J AM ACAD DERMATOL 1995;33: 124-6) on the response of deep tufted angioma to interferon alfa. The authors describe extension of the lesion through subcutaneous tissue into fascia and superficial muscle. They claim that no previous examples of extension of rafted angioma into fascia or muscle have been noted. W e reported deep tufted angioma on the thigh and buttock of a 10-week-old child that with magnetic resonance imaging showed interdigitation with the superficial fibers of the ghiteus maximus. 1 W e agree, however, that such deep extension is rare because our review of 31 cases of tufted angioma revealed no other cases with extension through the subcutis. Our patient was unresponsive to interferon alfa at a dose of 2 million U/m 2 over a 6-week period. The treatment had to be discontinued because the lesion had increased from 7 x 5 c m to 9 x 6 cm; thrombocytopenia had developed and liver function tests showed abnormalities. A good response was subsequently achieved with systemic steroids. There is no consensus regarding treatment of these lesions. Pulsed dye laser has been used with good results in one case, e in addition to the successful use of an argon tunable-dye laser cited by Suarez and colleagues. Inter-
feron alfa and systemic steroids as well as laser therapy should, therefore, be considered in the treatment of this rare tumor.
S. Munn R. Russell Jones Dermatology Department Hammersmith Hospital Du Cane Road London WI2 0NN, U.K.
REFERENCES 1. Munn SE, Jackson JE, Russell Jones R. Tufted hemangioma responding to high dose systemic steroids. Clin Exp Dermatol 1994;19:511-4. 2. Frenk E, Vion B, Merot Y, et al. Tufted angioma. Dermatologica 1990;181:243-3.
Reply To the Editor: W e appreciate the letter by Drs. Munn and Russell Jones. W e regret that we did not include this report in our article, l, 2 The central portion of this tufted angioma that involved underlying muscle appeared to respond after 10 days of interferon alfa at I million U/mg. However, the periphery advanced and platelet sequestration developed after doubling of the dose for 4 weeks, a scenario reminiscent of Kasabach-Merritt syndrome and not typical of a tufted angioma. After 6 weeks of prednisone at 2 mg/kg per day, the lesion stabilized and platelet count increased. W h y this tufted angioma responded to prednisone and not to interferon alfa is unknown. Our experience with patients and the literature suggests that patients with complicated hemangiomas or Kasabach-Merritt syndrome (rapidly enlarging hemangioma with platelet sequestration), or both often respond to either systemic interferon alfa or corticosteroids. The relatively recent recognition of tufted angioma as a distinct lesion will no doubt lead to a higher number of case reports and development of clearer treatment guidelines. S. M. Suarez, MD J. Pensler, AID A. Pallet, MD Departments of Pediatrics, Dermatology, and Surgery Northwestern University Medical School Evanston, Illinois
REFERENCES 1. Munn SE, Jackson JE, Russell-Jones RR. Tufted hemangioma responding to high-dose systemic steroids: a case report and review of the literature. Clin Exp Dermatol 1994; 19:511-4.