Poikilodermatous plaque-like hemangioma: A benign vasoformative entity with reproducible histopathologic and clinical features

Poikilodermatous plaque-like hemangioma (PPLH) is a recently described benign vasoformative entity with only 16 cases reported to date. We present an additional case of a 90-year-old male who presented with a 2-year history of a relatively large, asymptomatic, atrophic plaque on his left buttock. The lesion was initially smaller and grew before stabilizing in size. The patient denied preceding trauma or injury at this site as well as the presence or history of any similar lesions elsewhere. Physical examination revealed a reniform atrophic pink plaque with peripheral hyperpigmentation and overlying cigarette paper wrinkling. Given this appearance, scar or post-inflammatory changes were favored clinically, but lack of preceding trauma raised clinical concerns for poikilodermatous mycosis fungoides. Given the location and appearance, a broad shave biopsy was performed to rule out mycosis fungoides. Histopathologic examination revealed an increased density of superficial endothelial-cell-lined vessels, telangiectasias with sludging and congestion of superficial dermal vessels and loss of elastic tissue fibers in the lesional area. These findings, in the context of the clinical history, were consistent with this newly described hemangioma. We present this case to increase awareness amongst dermatopathologists of the reproducible clinical and histopathologic findings of this new benign vasoformative entity.