Verrucous Venous Malformation-Subcutaneous Variant: Diagnosis and Management.

INTRODUCTION: This study aimed to characterize the clinical, radiological, and histopathological features of the rare and often misdiagnosed verrucous venous malformation-subcutaneous variant (VVM-SV) and evaluate its management outcomes. METHODS: We conducted a retrospective review of 33 patients with histopathologically confirmed VVM-SV from three centers (2010-2025). Collected data included demographics, clinical presentation, imaging findings, prior treatments, and surgical outcomes following open (n = 6) or endoscopic (n = 9) excision. RESULTS: Most patients (30/33) were initially misdiagnosed, commonly as a common venous malformation, and 29 had undergone unsuccessful sclerotherapy. Typical presentation was a solitary, firm, bluish subcutaneous nodules, most often on the finger (n = 21). Imaging and surgical findings revealed a well-circumscribed, nodular mass with minimal venous flow. Histopathology confirmed that adipose tissue was surrounded by well-demarcated venous channels. Surgical excision was curative in all 15 operated patients, with no recurrences over a median follow-up of 19 mo. CONCLUSIONS: VVM-SV is a distinct clinicopathological entity frequently misdiagnosed, leading to inappropriate treatment. Accurate diagnosis relies on clinicopathological correlation, recognizing its subcutaneous location and minimal flow. Surgical excision is the definitive curative treatment.