The utility of dermoscopy in paediatric vascular anomalies.

Abstract

Background Vascular anomalies show highly variable morphology, making clinical identification difficult. Dermoscopy is a non-invasive tool which can aid in their diagnosis, but studies of dermoscopy in vascular anomalies are limited. Aim This study aimed to describe the dermoscopic findings in vascular anomalies in children and evaluate their usefulness over clinical examination alone. Methods Consecutive children with congenital or acquired vascular lesions diagnosed by two experienced dermatologists after detailed history and examination were recruited. Predominant dermoscopic findings of a representative lesion were recorded in a pre-designed proforma with a consensus of two dermatologists trained in dermoscopy. In cases of clinical diagnostic uncertainty, suitable histopathological and radiological investigations were done. Results Sixty-one patients (33 tumours, 26 malformations, and 2 unclassified anomalies) were recruited. The most observed condition was infantile haemangioma (IH) (37.7%) which showed red lacunae and irregularly branched thick-tortuous and thin-serpentine vessels in mixed haemangiomas (30.4%), prominent lacunae in superficial haemangiomas (34.8%) and only branched vessels in deep and treated/involuting (34.8%) haemangiomas. Lacunae were predominantly seen in superficial haemangiomas (p=0.0498) and were missing in deep and involuting haemangiomas (p=0.0027). Port-wine stain (13.1%) showed irregular reticular vessels along with dots and globules with thickness of the network being proportionate to the darker shade clinically. In all, there were nine (14.75%) cases where there was diagnostic uncertainty using clinical features alone and histopathological/radiological investigations were required to establish the final diagnosis. In them, dermoscopy showed findings (as described in previous literature) suggestive of the correct final diagnosis. Limitations Histopathological and radiological investigations were done only in cases where the clinical diagnosis was uncertain. Conclusion Dermoscopy is a useful tool in differentiating between different vascular anomalies such as IH and capillary malformations (CMs) which have different management strategies. Dermoscopy may also be useful in differentiating superficial from deep haemangiomas and proliferating from involuting haemangiomas. It can also help in determining the depth of CMs. Thus, it can obviate the need for invasive diagnostic procedures in paediatric vascular lesions and can guide appropriate treatment and prognosis.