Atypical Vascular Lesions of Skin

Atypical Vascular Lesions of Skin

The majority of atypical vascular lesions (AVLs) present as small raised brown papules in the radiation field image. The 2nd most common appearance is as an ill-defined erythematous patch image.

AVLs consist of anastomosing vascular channels within the dermis. The spaces usually appear empty (appearing as flesh-colored papules) but may be filled with blood (appearing as erythematous plaques).



  • Atypical vascular lesion (AVL)


  • Benign lymphangiomatous papules

  • Lymphangioma circumscriptum

  • Benign lymphangioendothelioma

  • Acquired progressive lymphangioma

  • Acquired lymphangiectasis


  • Proliferation of endothelial-like cells within dermis of skin several years after exposure to therapeutic radiation treatment



  • These lesions are only seen in clinical setting of prior radiation treatment for carcinoma

    • Young women treated with radiation therapy for Hodgkin disease are at increased risk for breast carcinoma

      • AVLs have not been reported following radiation for Hodgkin disease

    • Reason why Hodgkin disease patients are not affected is not known

      • May be related to age at exposure and dosage

  • Radiation may damage cells lining lymphatics and small blood vessels

    • Radiation damage may cause abnormal proliferation

  • Typical time from radiation exposure to diagnosis of AVL: 3-4 years



  • Gender

    • Only women have been reported to be affected


  • 2 types of AVLs

    • Lymphatic type (2/3)

      • Present as soft, flesh-colored (or pink to brown) papules, fluid-filled vesicles, or plaques

    • Vascular type (1/3)

      • Present as erythematous plaques or nodules

      • Gross appearance can closely mimic angiosarcoma

    • Patients may have lesions of both types


  • Complete excision of lesion is generally required for diagnosis and treatment

    • In some cases, diagnostic features of angiosarcoma are apparent after complete excision

    • Benign-appearing lesions may progress to angiosarcoma over period of years

      • Complete excision may reduce likelihood of this


  • Majority of cases do not recur or develop malignancy after complete excision

    • However, 10-20% of patients experience recurrence at same site with AVL or develop new lesions

  • Rare patients progress to cutaneous angiosarcomas

    • It may be difficult to determine if angiosarcoma arose from AVL or is independent lesion


General Features

  • Initial specimen may be incisional biopsy

    • Skin lesion is usually not discernible in these small specimens

  • In complete excisions, raised papule or vesicular lesion should be evident

Jul 6, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Atypical Vascular Lesions of Skin

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