Definition And Description

Naevus Vascularis is simply a localized increase in the size of the capillary blood-vessels distributed to the skin and subcutaneous tissue, and as one or both of these organs are involved, the disease will possess a more superficial or more profound character. Naevus vascularis is usually a congenital affection - that is to say, it is usually noticed at the time of birth, or shortly after, and when first perceived may present a lesion not larger than a pin's head. The three important forms of naevus vascularis are the superficial or flat, the deep, and the tuberous. The flat form, called "wine-mark," appears at first sight to be nothing more than a red or purplish macular staining of the skin. On closer inspection, however, this color is found to be due to the blood contained in abnormally enlarged capillaries. This naevus may be single, and a mere macule not larger than a split pea, or may be coin-sized, or even a large patch involving half the integument of the face; or there may be several patches of somewhat irregular form scattered over different parts of the body. The lesion may be perfectly flat and without the slightest elevation, so that by touch alone it would be difficult and even impossible to distinguish the abnormal from the normal portions of the integument. In other cases the affected portions convey to the finger a slight sensation of fulness. The affection in the flat form appears to be confined to the papillary vessels, or more probably to the vessels constituting the superficial cutaneous plexus.

In the deep form the larger vessels of the deep cutaneous plexus, together, sometimes, with those of the subcutaneous tissue, are implicated, and a more or less prominent tumor is formed, the outermost strata of the skin being, perhaps, not much altered, except by being pushed out and stretched over the tumor.

The tuberous form involves the vessels of both the superficial and deep plexus, and constitutes a projecting tumor of varying size, the degree of capillary enlargement varying also in different cases.

Besides these there are certain mixed forms in which all the vessels of the skin, as well as those of the connective tissue, are implicated. These naevi present the characters of tumors more or less sharply defined, of doughy or spongy feel, and capable, by pressure, of being greatly reduced in size, but returning to their previous dimensions on removal of the pressure. The tumors themselves may have a smooth and rounded outline, or, on the other hand, may be studded with irregular projections. The color is always darker than that of the normal skin, and varies in hue between that of arterial and that of venous blood. Sometimes while the prevailing tint may be venous, limited points present a bright arterial color.

Course

The lesions mentioned pursue an indefinite course, and one that cannot be predicted in advance. On the one hand they may never increase in size, but having existed a certain length of time may gradually disappear.

Secondly, they may increase more or less rapidly for a time, then come to a standstill, or after a time retrograde.

Thirdly, they may increase slowly or rapidly, and in doing so inflict serious damage on surrounding parts, or, by rupture of some of the distended vessels, severe and even fatal hemorrhages may occur.

Fourthly, they may undergo malignant degeneration.

Diagnosis

In the simple or superficial form - the so-called wine-mark - unless very minute, no difficulty need be experienced in diagnosis. The very small and bright colored ones are, however, to be distinguished from Angioma, which is an acquired and not a congenital affection. In the deep and tuberous forms the diagnosis rarely presents the slightest diffi-culty, the color, the spongy texture, the diminution of size on pressure being the characteristic features. That one may be deceived in these respects, however, 1 know from personal experience, as some years ago I dissected out a tumor, the size of a pullet's egg, in the presence of two accomplished surgeons, who after careful examination agreed with me in the diagnosis of naevus. Examination of the tumor, after the operation, revealed the fact that it was a melano-sarcoma and not a naevus.

Prognosis

The prognosis in Naevus is a little uncertain. In the superficial wine-mark form, it must be confessed that no method of treatment yet devised has been followed by brilliantly gratifying results. In the other forms the prognosis is usually good, that is, the affection can generally be controlled, but frequently this is not very readily accomplished.