Giant proliferative hemangiomas arising in a port-wine stain

A 57-year-old white man with a long-standing nevus flammeus stain on the posterior aspect of the right side of his scalp had a l-month history of rapidly growinglesions within it. Examination revealed a 4 em, pedunculated, erythematous tumor on the posterior aspect of the inferior parietal scalp on his right side and a 6 em lobulated, pedunculated, oozing hemorrhagic tumor in the occipitalposterior neck region (Fig. I). Both tumors arose in a bright red-purple patch located on the right side of the posterior scalp and neck. Laboratory studies revealed a hematocrit of 15%, most likely caused by oozing of blood from the tumors. The patient was treated with iron replacement, and 2 months later his hematocrit was 35%. Computed tomography of the scalp revealed that both tumors extended to the subcutaneous fat with no involvement of the deeper scalp layers. Both lesions were excised. Histologic findings included a superficial component composed of lobules of capillaries separated by edematous stroma that is consistent with a pyogenic granuloma. The reticular dermis contained