Clinical Challenge: Asymptomatic Purple Papule on the Arm

Targetoid hemosiderotic hemangioma, also known as hobnail hemangioma, was first described as a solitary, vascular, targetoid-appearing lesion by Santa Cruz and Aronberg in 1988.1 In most cases, the lesion occurs as a solitary, targetoid papule located on the trunk and extremities...

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Targetoid hemosiderotic hemangioma, also known as hobnail hemangioma, was first described as a solitary, vascular, targetoid-appearing lesion by Santa Cruz and Aronberg in 1988.¹ In most cases, the lesion occurs as a solitary, targetoid papule located on the trunk and extremities of young or middle-aged individuals and is equally distributed between the sexes.²

Sahin et al describes 2 stages of targetoid hemosiderotic hemangioma: early and late.³ In the early stage, the lesion may appear as a violaceous papule, 2 mm to 3 mm in diameter. Over time, the ecchymotic ring expands outwardly until it disappears spontaneously. In the later stages, however, the central papule remains as a slightly raised dermal lesion with a purple to brownish discoloration.³

Dermoscopy is useful in differentiating the lesion from melanoma as it reveals bluish-red channels.³ Histopathology shows vascular spaces lined by protuberant endothelial cells, creating a hobnail appearance.

The etiology of targetoid hemosiderotic hemangioma is unknown, although some lesions are thought to be related to localized trauma.⁴  Simple excision of the lesion is curative.

Greg Forsyth, PA-C, is a physician assistant at the DermDox Center for Dermatology in Mechanicsburg, Pennsylvania, and Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Santa Cruz DJ, Aronberg J. Targetoid hemosiderotic hemangioma. J Am Acad Dermatol. 1988;19(3):550-558.

2. Cotell S, Silverman A, Katta R. What is your diagnosis? Targetoid hemosiderotic hemangioma. Cutis. 2003;72(1):24, 51-52.

3. Sahin MT, Demir MA, Gunduz K, Ozturkcan S, Türel-Ermertcan A. Targetoid haemosiderotic haemangioma: dermoscopic monitoring of three cases and review of the literature. Clin Exp Dermatol. 2005;30(6):672-676.

4. Christenson LJ, Stone MS. Trauma-induced simulator of targetoid hemosiderotic hemangioma. Am J Dermatopathol. 2001;23(3):221-223.