Acquired Capillary Haemangioma of Eyelid
Acquired Capillary Haemangioma of Eyelid (Cherry haemangioma, senile haemangioma) is a common skin lesion in middle aged and older patients. Virtually, it occurs in all adults at one time or the other. The lesions may be small and may be ignored. The number of haemangiomas varies from one to two in children to even up to hundred in some elderly patients. Most commonly it affects chest or extremities, but can occasionally affect eyelids and periocular area. It varies in size from being barely visible to a dome shaped bright red swellings about 5 mm in diameter.
Histologically, acquired haemangioma is identical to infantile capillary haemangioma.
Haemangiomas are managed by observation over time for any increase in size or are surgically removed for cosmetic reasons.
References
Biswas Arnab. Eyelid Tumors- Clinical Evaluation and Reconstruction Techniques. Springer India 2014. P 73.
Shields Jerry A, Shields Carol L. Eyelid, Conjunctival, and Orbital Tumors- An Atlas and Textbook Second Edition. Lippincott Williams & Wilkins, a Wolters Kluwer business 2008. P 140- 141.
Mannis Mark J, Holland Edward J. CORNEA- Fundamentals, Diagnosis and Management Fourth Edition. Elsevier Inc. 2017. P 325.
Pasquali Paola. Cryosurgery- A Practical Manual. Springer- Verlag Berlin Heidelberg 2015. P 135.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244751/
Solitary acquired haemangioma of the eyelid appear as distinct red to red-blue papule ranging in size from about 0.5 mm to 5 mm in size.
Patient may present with bleeding haemangioma following trauma.
The acquired capillary haemangioma looks similar to mature type of congenital capillary haemangioma.
Hormonal changes during puberty and pregnancy may cause the development of vascular lesions. Trauma and irritative agents may act as inciting factors for production of capillary haemangioma.
Clinically, solitary acquired capillary haemangioma of eyelid may present as a red to red-blue papule which may range from 0.5 to 5 mm in size. Smaller lesions are red in colour and the larger ones give a bluish appearance. These may become pedunculated with cherry-like surface irregularity, hence the name cherry haemangioma. It generally moves with the skin. Localised haemangiomas are usually very compressible. It may bleed following trauma.
Pathology
Histopathologically, in early stages, acquired capillary haemangioma is similar to congenital capillary haemangioma. It shows newly formed capillaries with narrow lumina and prominent endothelial cells arranged in lobular fashion.
In fully matured lesion, the vascular lumen is dilated, the endothelial cells more flattened, and the stroma is oedematous and hyalinised. In acquired capillary haemangioma, there is less capillary proliferation as compared to a similar condition called pyogenic granuloma.
Differential diagnosis
Pyogenic granuloma: Some authorities consider acquired capillary haemangioma to be closely related to pyogenic granuloma. But pyogenic granuloma shows more endothelial proliferation than capillary haemangioma. The term capillary haemangioma of the pyogenic granuloma type is applied to this lesion.
Angiosarcoma
Cavernous haemangioma
Eyelid varix
Most acquired capillary haemangiomas are just observed over time, since they are generally small and have no malignant potential.
Surgical therapy
Complete excision of the larger haemangiomas may be resorted to for cosmetic reasons. Electrodissection, cryotherapy or radioablation may be done to destroy the growth.
Prognosis is usually good.