Initial presentation of stasis dermatitis mimicking solitary lesions: A previously unrecognized clinical scenario

• Published in: Journal of the American Academy of Dermatology 2009-12, Vol.61 (6), p.1028-1032
• Main Authors: Weaver, Joshua, MD, Billings, Steven D., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Dermatology; Diagnosis, Differential; Female; Humans; Leg Dermatoses - diagnosis; Leg Dermatoses - etiology; Leg Dermatoses - pathology; Male; Middle Aged; Skin - pathology; Skin Neoplasms - diagnosis; Venous Insufficiency - complications
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2009.04.025

Background Stasis dermatitis is a common skin condition secondary to chronic venous insufficiency. Characteristic dermatologic changes in well-developed disease include bilateral erythematous, scaly, and slightly discolored papules and plaques on the lower legs. Earlier signs, such as prominent superficial veins and pitting ankle edema, are well known. Early recognition of signs and appropriate diagnosis can lead to timely treatment that can prevent painful complications, such as leg ulcers which are at risk for development of squamous cell carcinoma. Objective Herein we describe a yet unrecognized early sign of venous dermatitis—a solitary lesion, some mimicking neoplastic processes. Methods Thirty-seven cases of stasis dermatitis submitted with the clinical diagnosis of a solitary lesion were identified. Thirty-three had no clinical history of venous insufficiency. All cases of stasis dermatitis presenting for the first time as a solitary lesion were reviewed retrospectively both clinically and pathologically. Results Squamous cell carcinoma was most commonly suspected (33%), followed by basal cell carcinoma (24%), and a variety of other solitary lesions. The histopathology was characteristic of stasis dermatitis in all cases with absent or mild spongiosis (82%), variable acanthosis and dermal fibrosis, and proliferation of papillary dermal thick-walled vessels were prominent (2-3+) in nearly all cases (≥90%) along with hemosiderin-laden macrophages and extravasated red blood cells (≥95%). Limitations The study is limited by its retrospective nature and absence of clinical images on all cases. Conclusion Stasis dermatitis may present as a solitary lesion mimicking a neoplasm. Early recognition of stasis dermatitis can lead to appropriate treatment and possibly prevent further morbidity.