Answer: Can you identify this condition?

4. Senile hemangioma

Senile hemangiomas (or angiomas or De Morgan spots) are the most common benign acquired vascular malformations.^1–3 They occur in nearly all adults older than 30 years, increasing in number with age. Clinically, these hemangiomas are often incidentally noted on physical examination. Senile hemangiomas often appear as numerous red, firm maculopapular spots, less than 5 mm in diameter, mainly on the trunk and arms.^4,5 Direct trauma can elicit bleeding.

The cause and pathophysiology of senile hemangiomas are unclear, but they mainly derive from the venous limb of the capillary loop and have a unique collagen composition.^6,7 They increase in number during pregnancy, suggesting a hormonal influence.¹ They have also been associated with solid-organ transplantation, graft versus host disease, and exposure to various different chemicals; however, a causative relationship has never been established.^8–10

Diagnosis is clinical and based on the appearance and characteristics of the lesions, as outlined above. Senile hemangiomas differ in appearance and distribution from other cutaneous acquired vascular malformations. Venous lakes are larger dark blue, dome-shaped lesions, typically found on sun-exposed areas of the skin, most often the vermillion border of the lip, the face, and the ears of elderly people. Angiokeratomas are superficial dermal blood vessels, with hyperkeratosis of the overlying epidermis, most commonly found on the scrotum or vulva. Lymphangioma simplex consists of small translucent vesicles on a red-brown base, usually made up of a mixture of dilated vascular and lymph channels. Kaposi sarcoma is a vascular hemorrhagic neoplasm most often found in patients with AIDS or in men older than 60 years.¹ Atypical lesions or lesions that have acutely changed should trigger a more thorough investigation, which might include referral to a dermatologist or plastic surgeon.

Senile hemangiomas are clinically insignificant; reassurance is the only treatment required. Their natural course is one of atrophy and fading with age.⁵ Treatment can be sought for cosmetic reasons; scissor excision, electrodessication, or laser desiccation and curettage have all been shown to be effective, while cryotherapy has not.^1,5