Capillary Angioma
The most common form of capillary angioma is the nævus or congenital telangiectasis.
Nævus.—A nævus is a collection of dilated capillaries, the afferent arterioles and the efferent venules of which often share in the dilatation. Little is known regarding the etiology of nævi beyond the fact that they are of congenital origin. They often escape notice until the child is some days old, but attention is usually drawn to them within a fortnight of birth. For practical purposes the most useful classification of nævi is into the cutaneous, the subcutaneous, and the mixed forms.
The cutaneous nævus, “mother's mark,” or “port-wine stain,” consists of an aggregation of dilated capillaries in the substance of the skin. On stretching the skin the vessels can be seen to form a fine network, or to run in leashes parallel to one another. A dilated arteriole or a vein winding about among the capillaries may sometimes be detected. These nævi occur on any part of the body, but they are most frequently met with on the face. They may be multiple, and vary greatly in size, some being no bigger than a pin-head, while others cover large areas of the body. In colour they present every tint from purple to brilliant red; in the majority there is a considerable dash of blue, especially in cold weather.
Unlike the other forms of nævi, the cutaneous variety shows little tendency to disappear, and it is especially persistent when associated with overgrowth of the epidermis and of the hairs—nævoid mole.
The treatment of the cutaneous nævus is unsatisfactory, owing to the difficulty of removing the nævus without leaving a scar which is even more disfiguring. Very small nævi may be destroyed by a fine pointed Paquelin thermo-cautery, or by escharotics, such as nitric acid. For larger nævi, radium and solidified carbon dioxide (“CO2 snow”) may be used. The extensive port-wine stains so often met with on the face are best left alone.
The subcutaneous nævus is comparatively rare. It constitutes a well-defined, localised tumour, which may possess a distinct capsule, especially when it has ceased to grow or is retrogressing. On section, it presents the appearance of a finely reticulated sponge.
Although it may be noticed at, or within a few days of, birth, a subcutaneous nævus is often overlooked, especially when on a covered part of the body, and may not be discovered till the patient is some years old. It forms a rounded, lobulated swelling, seldom of large size and yielding a sensation like that of a sponge; the skin over it is normal, or may exhibit a bluish tinge, especially in cold weather. In some cases the tumour is diminished by pressing the blood out of it, but slowly fills again when the pressure is relaxed, and it swells up when the child struggles or cries. From a cold abscess it is diagnosed by the history and progress of the swelling and by the absence of fluctuation. When situated over one of the hernial openings, it closely simulates a hernia; and when it occurs in the middle line of the face, head, or back, it may be mistaken for such other congenital conditions as meningocele or spina bifida. When other means fail, the use of an exploring needle clears up the diagnosis.
Mixed Nævus.—As its name indicates, the mixed nævus partakes of the characters of the other two varieties; that is, it is a subcutaneous nævus with involvement of the skin.
It is frequently met with on the face and head, but may occur on any part of the body. It also affects parts covered by mucous membrane, such as the cheek, tongue, and soft palate. The swelling is rounded or lobulated, and projects beyond the level of its surroundings. Sometimes the skin is invaded by the nævoid tissue over the whole extent of the tumour, sometimes only over a limited area. Frequently the margin only is of a bright-red colour, while the skin in the centre resembles a cicatrix. The swelling is reduced by steady pressure, and increases in size and becomes tense when the child cries.