Solitary angiokeratoma of the tongue in children: Diagnostic pitfalls and management considerations

Solitary angiokeratoma (AK) of the tongue is a rare vascular lesion that presents a diagnostic challenge owing to its clinical resemblance to other vascular and pigmented oral lesions. Histopathologically, it is characterized by dilated capillaries in the papillary dermis, often accompanied by overlying hyperkeratosis, acanthosis, and occasionally organizing thrombi. We report two cases of solitary AK located on the dorsal midline of the tongue, presenting at birth and in adolescence, both associated with intermittent, self-limiting bleeding. In one case, the lesion was initially diagnosed and managed as a hemangioma, underscoring the difficulty of clinical diagnosis. A definitive diagnosis was made based on histopathological examination. Both patients underwent local surgical excision; however, one patient experienced recurrence a decade later, necessitating a repeat surgery. These cases emphasize the need for a comprehensive differential diagnosis when assessing tongue lesions in children and adolescents, and the critical role of histopathology in guiding appropriate management.