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We read with great interest the article by Knispel and Shaw¹ on cutaneous ulceration as the initial presenting manifestation of a hemangioma of infancy, which appeared in the "Off-center Fold" section of the March 2001 issue of the ARCHIVES. We agree that this manifestation represents an important, albeit uncommon, clinical presentation of hemangioma of infancy. In addition to the report by Rekant and Katz² that was cited by the authors, we reported 3 cases of perineal ulcers as the presenting manifestation of a hemangioma of infancy, as well as a fourth case with an identical presentation in the perioral area.³

Although Drs Knispel and Shaw found histologic examination of skin biopsy specimens helpful in their case, the histologic findings were not diagnostic in our cases even when viewed retrospectively after the clinical diagnosis became obvious. Skin biopsy specimens did demonstrate increased cutaneous vascularity but not to a degree significantly different . . . [Full Text of this Article]

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