Facial Vascular Lesions

Facial Vascular Lesions
Cervical cystic Lymphangioma
  • Congenital o appear in infancy
  • Incidence 1/6000 - 1/6000
  • Benign but progressive & can compress vital structures
  • Surgery +/- corticosteroids & sirolimus
Spider angiomas
  • Epidemiology
    • Children 7-10 yo
    • Pregnancy
    • Liver disease
  • Single or multiple
  • Central dilated (sometimes pulsatile) arteriole → blood flow into superficial capillary network
  • Some lesions in children regress spontaneously but many persist
  • Harmless but many cause parental anxiety & request for treatment
  • Treatment:
    • PDL
    • Pode se fazer azoto líquido só 5s em vez de laser (para evitar hipopigmentação)
Pyogenic granulomas
  • Common, especially in children and young adults (including pregnancy)
  • Arise de novo or after minor penetrating trauma → benign proliferation of small blood vessels with rapid exophytic grwoth → globular pedunculated tumor
  • Histology resembles granulation tissue, typically with lobulated pattern (name misnomer)
  • Any site especially fingers, feet, lips, head, neck, upper trunk, head & neck commonest site in large review
  • DDx
    • Amelanotic melanoma
    • Kaposi sarcoma
    • Bacillary angiomatosis
  • Dermoscopy features
    • Distinct keratinised border forming white collarette
    • Vascular structures usually present with red homogenous areas with no clear lacunar pattern
    • White linear “rail lines”
  • Treatment
    • Curettage & cautery (spoon currete)
    • Topical timolol
    • Potent topical steroids
    • Imiquimod 5%
    • Surgical excision
    • Vascular lasers
Venous lake
  • Bluish-purple soft swelling on lower lip, face & eats of elderly patients
  • Empties on diascopy
  • Histology: dilated thin-walled venules without proliferation of vascular tissue found in true angioma and degeneration of surrounding connective tissue
  • Treatment
    • Excision
    • Electrocautery
    • Laser
      • PDL +/- perspex compression
      • NdYag