A 10-year-old boy presented with 1-year history of a gradually progressive non-tender, soft-to-firm, dome-shaped, brownish-black papule (6x6 mm) with a peripheral erythematous halo situated above the umbilicus (Fig. 1). There was no history of preceding trauma, acute illness or any drug intake. Other mucocutaneous areas were uninvolved. Excision biopsy confirmed the clinical impression of targetoid hemosiderotic hemagioma (THH); no recurrence was noted on regular follow-up.

Fig. 1 Targetoid hemosiderotic hemagioma characterized by a dome-shaped, brownish-black papule with surrounding erythe-matous halo.

THH is an acquired benign vascular lesion presenting as a solitary, red-violaceous to brown targetoid papule with a hemorrhagic halo; usually adolescent onset. Classic histology shows biphasic pattern: dilated vessels lined by hobnail endothelial cells with intraluminal papillae in the papillary dermis; and angulated and slit-like vascular spaces dissecting the collagen bundles in the reticular dermis, with plenty of extravasated erythrocytes and hemosiderin deposition at the periphery (accounting for the targetoid appearance). They are often misdiagnosed as melanocytic nevus (coarse hair, absence of halo, presence of melanocytic nests), infantile hemangioma (bright red lobulated plaque with typical growth pattern), dermatofibroma (painful, positive dimpling sign), solitary angiokeratoma (no halo, hyperkeratosis and dilated vessels only in papillary dermis on histology) or melanoma (rare in pre-pubertal age, atypical melanocytic nests). Complete removal is sufficient to treat the condition.