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Editor,—Capillary haemangiomas usually present within the first weeks or months of life. Less commonly they can present at birth. To our knowledge only one other report exists of the occurrence of acquired capillary haemangioma of the eyelid in an adult.1 Our case is the first reported acquired capillary haemangioma to be treated with cutting diathermy.
A 40 year old man was referred to the oculoplastics clinic for evaluation of a left upper eyelid mass. The lesion first appeared 9 months earlier and had gradually increased in size. The patient was otherwise fit and well—in particular, there was no history of other cutaneous lesions or antecedent trauma.
On examination the visual acuities were 6/6 unaided bilaterally. Examination of the adnexa revealed a dusky red pedunculated mass of the left upper eyelid and a mechanical ptosis (Fig 1). Telangiectatic vessels were noted above the lesion. Clinically the appearance was consistent with a capillary haemangioma. The remainder of the ophthalmic and orbital examination was normal. Excision of the lesion was performed with the Ellman cutting diathermy. Haemostasis was maintained throughout the procedure. The wound was sutured with interrupted 6-0 Prolene.
Histopathological examination of the 1 × 0.7 × 0.6 cm pedunculated nodular mass revealed numerous capillary lumina lined by endothelial cells. No cellular atypia or mitotic figures were noted (Fig2).
The patient was assessed 2 weeks postoperatively. The wound had healed and the sutures were removed. The previously noted telangiectatic vessels were now not clinically evident. There has been no recurrence of the lesion after 6 months of follow up.
Capillary haemangiomas are the most common congenital vascular tumours of the periorbital region.2 The majority of capillary haemangiomas appear over the first weeks or months of life. The natural history of the lesion is that of increasing size to 1 year of age and then gradual regression during the next 4–5 years. Intralesional corticosteroid injection is the current treatment of choice. Other treatment methods employed include excisional biopsy and carbon dioxide laser.
Acquired capillary haemangioma of the eyelid in an adult is a very rare occurrence and has been reported only once in the literature.1 Our diagnosis was made after exclusion of other similar presenting lesions. The differential diagnosis would include Kaposi's sarcoma, cavernous haemangioma, angiosarcoma, varix, acquired tufted angioma, and intravascular papillary endothelial hyperplasia.
Our choice of treatment proved to be very successful. The lesion was removed in its entirety and the postoperative cosmetic result was excellent. The technique was easy to perform for two reasons; firstly, the Ellman cutting diathermy allowed cutting precision and haemostasis was maintained throughout the procedure. The size of the capillary haemangioma and its location in this case made it essential to incise around the edge of the lesion accurately and therefore avoid the necessity for skin grafting. The Ellman cutting diathermy was particularly well suited to this purpose. We would recommend this method for the treatment of similar lesions.
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