Arterial converging points and sharp S-curves: An anatomicalvascular hypothesis for facial skin tumour and pathogenesis
Background. An observation was made in 2004 by Holtan et al. by dermoscopic examination that skin tumours coincide with arterial blood supply. In 2006 the author proposed the hypothesis that these areas often coincide with areas where arteries join from multiple different directions, called arterial converging points (ACP), or with sharp S-curves in arteries.
Methods. The anatomical vascular observations were made through a prospective study dissecting 30 cadavers and comparing 60 hemi-foreheads. The arteries were filled with latex and then dissected meticulously to expose them.
Results. In all the foreheads there were anastomoses between arteries joining from different directions. These junctions are called ACP. There were also many sharp angled S-curves in the course of the arteries, which assisted in formulating a skin tumour pathogenesis. Based on the clinical knowledge of basal cell carcinoma growth sites in the face, an anatomical vascular hypothesis was developed. This may also play a role in migraine pathogenesis because of the relationship of the cutaneous nerves to the blood supply.
Conclusion. An association between ACP and certain skin tumours may be relevant in tumour pathogenesis, and further study of the vascular phenomena of ACP will provide more answers
W G Kleintjes, Western Cape Provincial Tertiary Adult Burn Unit, Division of Surgery, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
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Date published: 2020-05-19
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