The “Elastotic Hemangioma” of the Vulva Is Nodular Vulvar Elastosis With Prominent Vascularization

Acquired elastotic hemangioma is an uncommon benign cutaneous vascular proliferation first described in 2002 that typically presents as a solitary erythematous plaque arising on chronically sun-exposed skin. Histologically, it is characterized by a superficial, band-like, horizontally oriented capillary proliferation associated with marked solar elastosis. In contrast, vulvar elastosis develops in an anatomical site protected from ultraviolet radiation and has been linked to aging, hormonal changes, and inflammatory or reparative processes.In this article, we report the lesion of a 67-year-old woman with vulvar lichen sclerosus who presented with a palpable 1-cm nodule involving the left labium majus. Her medical history was notable for an undifferentiated ovarian carcinoma diagnosed 19 years earlier, treated with chemotherapy and currently in remission. Histopathological examination revealed superficial features of lichen sclerosus and, within the underlying dermis, a nodular accumulation of thick, irregular elastic fibers intermingled with numerous mature blood vessels lacking endothelial atypia.In conclusion, a prominent vascular component may represent a feature of nodular vulvar elastosis and should not necessarily be interpreted as evidence of a primary vascular neoplasm.