Disease directory
Acquired elastic hemangioma
Published: September 18, 2026Updated: September 18, 2026
Important: Informational content intended for healthcare professionals. It does not replace clinical evaluation or establish a doctor-patient relationship.
Overview
- Definition and names
- Acquired elastotic hemangioma (AEH) : benign vascular proliferation of the superficial dermis, characterized by a horizontal band of intimately interwoven capillaries with marked solar elastosis , in photoexposed adult skin. Requena 2002 , Martorell-Calatayud 2010 , Cohen 2017 , Jeunon 2020 .
- Considered a distinct clinicopathological variant of cutaneous hemangioma .
- History
- First described as a specific entity in 2002 by Requena, Kutzner and Mentzel , in a series of 6 patients, under the name “acquired elastotic hemangioma”. Requena 2002 .
- Subsequently expanded by series and reviews: 14 cases (Martorell 2010), 10 cases with immunohistochemistry (Tong 2010), 11 cases + review of 34 previous cases (Cohen 2017), systematic review of 49 cases (Jeunon 2020). Martorell-Calatayud 2010 , Tong 2010 , Cohen 2017 , Jeunon 2020 .
- Epidemiology
- Age: typically >50 years , average around 59–65 years. Cohen 2017 , Luce 2018 , Jeunon 2020 .
- Sex: slight female predilection in the first series, but larger reviews show an almost 1:1 female:male distribution (24 women, 21 men in 45 cases). Cohen 2017 , Jeunon 2020 .
- Location: almost always on chronically sun-exposed skin (forearm extensors, back of hands, lateral neck; also legs, back and upper trunk). Requena 2002 , Martorell-Calatayud 2010 , Cohen 2017 , Luce 2018 , Kharel 2020 .
- Race: cases mainly in Caucasian populations, but also described in other ethnic groups; probably underdiagnosed . Jeunon 2020 .
- Course: benign , with no documented recurrences or malignant transformation after excision or even observed in published series. Requena 2002 , Martorell-Calatayud 2010 , Cohen 2017 , Luce 2018 , Kharel 2020 .
- ICD Codes
- There is no specific code for HEA; it is coded as cutaneous hemangioma:
- ICD-10
- D18.0 – Hemangioma, any site. ICD-10 2019 .
- D18.01 – Hemangioma of skin and subcutaneous tissue. Gesundheit D18.01 .
- ICD-11
- 2E81.0 – Neoplastic hemangioma (benign neoplastic hemangioma; can be post-coordinated with “skin” site). ICD-11 2E81.0 , ICD-11 catalog 2022 .
- ICD-10
- There is no specific code for HEA; it is coded as cutaneous hemangioma:
- Diagnostic checklist (quick)
- Essential clinic
- Adult ≥50 years, highly photoexposed skin.
- Erythematous or violaceous plaque/macule, with well-defined borders, slow growth, asymptomatic.
- Location on the forearm, back of the hand, neck or other sun-exposed area.
- Dermatoscopy: homogeneous violet background, bright white structures ± punctate/glomerular vessels, without arborizing vessels typical of BCC.
- Histopathology required
- Proliferation of thin-walled capillaries in a horizontal band in the superficial/upper reticular dermis.
- Intense solar elastosis surrounding and interposed between vessels.
- Swollen endothelium without significant atypia or frequent mitoses.
- Basic Immunohistochemistry
- CD31/CD34 positive in endothelium.
- HHV-8 negative (to exclude Kaposi) if there is clinical/histochemical doubt.
- D2-40 can be positive or negative; do not use it solely for reclassification.
- Key exclusions
- Without marked atypia, without deep infiltrative pattern or necrosis (if present, consider angiosarcoma or other malignant neoplasm).
- If clinical/histological findings do not match typical HEA, review differential diagnoses and consider a more extensive biopsy.
- Essential clinic
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