Images in Pathology: Verrucous Haemangioma

A 16-year-old male complained of a swelling on skin of volar aspect of the forearm, present since early childhood. At the age of eight years, the swelling had been excised, however, recurrence was noted within a few months. There was occasional pain and bleeding from the lesion. At the time of current presentation, patient gave the history that the swelling used to diminish on elevation of the arm. Physical examination revealed a soft, compressible 16 x 8 cm elevated skin lesion with a papillary keratotic surface with focal ulceration and haemorrhage. Smaller, discrete satellite nodules with a similar appearance were noted in the vicinity. A venogram was performed and the findings suggested a venous malformation. Complete excision of the lesion with skin grafting was performed. At surgery, it was found that the malformation enveloped the radial artery and extended along the flexor tendons.