Verrucous Hemangioma Mimicking Melanoma in an Elderly Man

Verrucous hemangioma (VH) is an uncommon, congenital, vascular anomaly that resembles angiokeratoma but it encompasses distinctive clinicopathological features. The differential diagnosis of this entity included all the hyperkeratotic vascular tumors and malformations and, especially in localized cases, pigmented lesions. VH lesions initially present at birth, and therefore, the diagnosis in the elderly may be difficult. We present a 77 year-old patient with a birth lesion on the back of his calf who came to the clinic with a two year history of enlargement of this lesion following trauma. We performed an excisional biopsy because clinical appearance simulated melanoma arising from a congenital nevus. Nevertheless, the histopathological examination revealed a verrucous hemangioma. A diagnosis of VH should be considered in erythematous papules, nodules, and plaques, especially those that are hyperkeratotic, present at birth, located on the lower extremities, and show growth after trauma or infection.