Verrucous venous malformation (subcutaneous variant) mimicking other benign soft tissue tumours; a paediatric case series

Subcutaneous VVM lacks the hallmark superficial features of classical VVM and may mimic other paediatric soft tissue tumors, such as lipomas or haemangiomas, leading to diagnostic error and unnecessary treatment. Despite sharing the same MAP3K3 mutation, these lesions differ in depth, clinical presentation, and behavior. We propose reconsidering the terminology, suggesting "cutaneous MAP3K3-related slow-flow vascular malformation" to encompass both superficial and subcutaneous variants. Recognition of this phenotype and its defining features, including focal GLUT-1 expression and MAP3K3 mutation, can support accurate diagnosis and reduce the risk of overtreatment. Further studies are needed to determine whether subcutaneous variants differ in recurrence risk, natural history, or systemic associations.