The dermoscopic examination of vascular lesions, including hemorrhages due to trauma, is of paramount relevance, because melanomas can be excluded with a high level of certainty. The following entities will be discussed in detail: hemangioma, angiokeratoma, subungual hemorrhage, and subcorneal hemorrhage. From a dermoscopic point of view the lowest common denominator of all these lesions is their reddish, reddish-blue to reddish-black coloration in the complete absence of pigment network structures and other melanoma-specific criteria.
The term hemangioma comprises various solitary vascular proliferations, such as arteriovenous hemangioma (cirsoid aneurysm), capillary aneurysm (thrombosed capillary aneurysm), cherry angioma (senile angioma), pyogenic granuloma, and venous lake, that may occasionally simulate a melanoma and therefore are often examined dermoscopically. Solitary lymphangioma is also mentioned here, since its dermoscopic features are basically identical with the so-called hemangioma group. Classic capillary and cavernous hemangiomas, commonly found in neonates, are not considered here, because the lesions are diagnosed clinically and dermoscopic examination is usually not performed.
The term angiokeratoma encompasses
several, unrelated conditions characterized by the combination of vascular proliferations and
hyperkeratosis. The different types of angiokeratomas are the
following: solitary angiokeratoma, angiokeratoma circumscriptum, angiokeratoma of Fordyce (angioma of scrotum and vulva), angiokeratoma of
Mibelli, and angiokeratoma corporis diffusum (Fabry’s disease). With regard to dermoscopy of pigmented skin lesions only solitary angiokeratoma is
pertinent. From a clinical point of view, the solitary angiokeratoma is a
small, warty, red-blue to black papule that may appear on any anatomic site with predilection for the lower
extremities. It can be regarded as a ‘pseudomelanoma’, since clinically it simulates melanoma.
Nail hemorrhage frequently occurs following trauma to the nail. Obviously, the extent of such a subungual hemorrhage depends on the intensity and force of the trauma. However, patients seeking the advice of a physician because of subungual hemorrhage never recall any trauma or even think of the possibility of a trauma, because otherwise they would not seek
consultation. The main clinical differential diagnoses of subungual hemorrhages are subungual nevi, subungual melanomas and, rarely, infections with fungi or bacteria, e.g. pseudomonas.
hemorrhage, also called black heel, talon noir or subcorneal
hematoma, is seen commonly on the heels of young individuals involved in sport activities such as tennis, basketball or soccer. Of
course, it is also found on the palms, resulting from lateral forces due to other sport
activities, e.g. tennis, golf or mountain climbing. As is the case with subungual
hemorrhage, individuals seeking medical advice never ever recall any trauma. Within a few
weeks, or within a few months when the soles are involved, subcorneal hemorrhage resolves