Eccrine angiomatous hamartoma in an adult

Abstract

© BMJ Publishing Group Limited 2021. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION A 71 yearold male patient presented with an erythematous nodular lesion, with 1 cm of diameter, on the lateral aspect of the left heel, evolving for 2 years. He also had surrounding oedema, fever and pain of acute onset without signs of abscess formation, consistent with an uncomplicated cellulitis episode. After being treated with cefazolin 2000 mg/8 hours and clindamycin 600 mg/6 hours, for 14 days, the inflammatory signs subsided and only a small ulcerated area was left overlying the lesion of the left heel, without drainage (figure 1). We performed two incisional biopsies on the left foot, initially a punch biopsy that was inconclusive, and 1 month later, a wedge biopsy that revealed an illdefined lesion composed of multilobular areas with myxoid stroma and capillarysized blood vessels in the deep dermis, accompanied by an increased number of otherwise normal eccrine glands (figure 2). These findings are consistent with eccrine angiomatous hamartoma (EAH). Although a complete excision was not performed, the lesion was not clinically identifiable after the second biopsy. The patient was asymptomatic and did not show local recurrence or other skin lesions after 4 years of followup. EAH is a rare, benign cutaneous tumour, of unknown aetiology. It begins more frequently at birth or during childhood, rarely appearing in adulthood. Clinically, the colour of EAH may be flesh coloured, bluebrown or reddish and may occur as a nodule, plaque, or less commonly, a macule, usually solitary, although cases with multiple lesions have been described. In most cases, EAH arises as a single lesion on the extremity, as in this patient. 2 It can present associated with hyperhidrosis, hypertrichosis and pain. 2 The differential diagnosis of EAH includes eccrine nevus, tufted angioma, vascular malformations, macular telangiectatic mastocytosis, nevus flammeus, glomus tumour and smooth muscle hamartoma. Histologically is characterised by a dermal proliferation of blood vessels and welldifferentiated eccrine secretor and ductal elements. Excision is usually curative although reserved for painful or cosmetically disfiguring lesions. 2