Verrucous malformations: Their presentation and management

Verrucous hemangiomas are a distinct subset of vascular malformations that have not been described extensively in the plastic surgery literature. They are characterized by reactive epidermal acanthosis, papillomatosis, hyperk eratosis, and extension into the subcutaneous tissues. In response to injur y, infection. or subtotal resection, they enlarge and become increasingly k eratotic. In light of contemporary definitions of hemangiomas and malformat ions, the authors recommended that these lesions be renamed verrucous malfo rmations. The authors review their evaluation and treatment of 6 patients w ith this lesion and offer an algorithm that emphasizes excision over ablati ve therapy. Of the 6 patients, 3 patients had failed either cryotherapy or laser removal by a nonsurgeon, with a consequent increase in lesion size an d discomfort. The lesions were all subsequently excised. Because of the siz e and location of the verrucous malformations, staged removal was required in 3 patients. Patients have been followed for as long as 7 years. A single recurrence was controlled with reexcision. Excision of verrucous malformat ions, rather than laser ablation or cryosurgery, is supported by the author s' favorable results.