Introduction

Angiokeratoma presents as a blood-filled papule which may bleed following trauma. There are a range of clinical presentations ranging from isolated lesions of little consequence to widespread lesions associated with Fabry disease. 

Histology of angiokeratoma

In angiokeratoma, the histopathology shows a vascular lesion in the superficial dermis which extends into the epidermis. There is epidermal hyperplasia and papillomatosis. There may be intravascular thrombosis (figures 1,2).

Figure 1

Figure 2

Special studies for angiokeratoma

None are generally needed.

Differential diagnosis for angiokeratoma

Other diagnoses to be considered include:

• Melanoma — this can be a clinical consideration, particularly when intravascular thrombosis causes the lesion to darken
• Verrucous haemangioma — this will also involve the deep dermis and subcutis (not a feature of angiokeratoma).