Hemangioma is the most common benign tumor of infancy and children.  They are blood vessel cell tumors.  The most common type of hemangioma is known as infantile hemangioma (IH).  These lesions are either not yet present at birth or are very small.  Over the first weeks of life this type of hemangioma will grow.  IH differs from a less common type of hemangioma called congenital hemangioma (CH) .  Congenital hemangiomas are fully formed at birth. 

Infantile hemangiomas have a varied appearance depending on the location of the lesion, the depth of the hemangioma and the size.

Hemangiomas are given common names based on their appearance.

Superficial Hemangioma formerly called Strawberry Hemangioma is located in the surface of the skin.  They are characterized by a bright red color with a well defined border.  These lesions may vary greatly in size, location and shape. 

Deep Hemangioma formerly known as Cavernous Hemangioma is often larger than a superficial lesion.  They are located beneath the surface of the skin and are characterized by a bluish lump or mass.  They are generally soft to the touch. 

A Combined Hemangioma or Mixed Hemangioma is both deep and superficial.  They may appear as a lump or mass in the skin with areas of red.  They are often soft.

Some superficial hemangiomas are very large. They cover a great surface area of skin.  These lesions are called Segmental, Difuse or Regional.

Hemangiomas are often referred to as birthmarks.  Recently medical professionals including the American Academy of Dermatology, the International Society for the Study of Vascular Anomalies and the Hemangioma Investigative group have recognized that hemangiomas are more complicated then the term birthmark implies.  It is for this reason that NOVA prefers to refer to Hemangioma as a vascular anomaly. 

Hemangioma is the most common pigmented lesion in infants and children.  It is reported that they are found in up to 4-10% of all infants.  The exact cause of these lesions is still unknown.  However; there is a great deal of research going on at several medical centers internationally to uncover the cause.   

Infantile Hemangiomas will typically grow for 9-12 months; some may grow up to about 18 months this is called the "growth or proliferative phase" of a hemangioma development. After completing the growth phase a hemangioma will plateau and then enter into a spontaneous regression period. This is called “involution”.  

The growth of a hemangioma is very unpredictable in very young infants. The most significant and rapid growth often occurs in those first few weeks of life.  The duration of the growth period seems to correlate with the size of the hemangioma.  The smaller hemangiomas have a tendency to grow for weeks – 6 months of age while the larger hemangiomas may grow for a year or longer.  Some hemangiomas involute slowly and others involute rapidly. Those that involute rapidly often will leave little to no evidence that a hemangioma was ever present. Hemangiomas that involute slowly, taking >5 years are more likely to leave residual scaring in the forms of fibro fatty tissue, small blood vessels and other scarring. While all Hemangiomas eventually 'involute" the result is not always cosmetically acceptable. Evaluation by an experienced physician can help to determine if a hemangioma should be treated or to be allowed resolve naturally. 

Most hemangiomas do not result in significant complications for the patient.  However; a significant number of patients may experience endangering complications including, pain, ulceration, infection, structural abnormalities, and interference with breathing, vision and hearing.  According to the American Academy of Dermatology, hemangiomas of infancy should be evaluated for these complications and treated accordingly. 

The treatment for complicated hemangiomas includes; medical management including steroid injections, oral steroids, and other pharmacological treatments like Vincristine, laser and surgical excision.

The psychological implications of facial disfigurement should not be ignored in the management of facial hemangioma. In a culture where “fitting in” seems to be more important then ever, Parents should consider that children become socially interactive at age 2-3 years of age when deciding on the timing of treatment.   Many physicians advocate treatment with the goal of restoring a more natural appearance in time for school.  Since many children are in preschool at very early ages families may want to discuss earlier intervention to account for earlier school settings.  Some families seek resolution surgically at a very young age due to the individual family dynamics.  Early intervention by an experienced physician may minimize the disfigurement and decrease the risk of psycho/social concerns, these issues need to be discussed in the context of the overall long term benefits to the child.

It is the opinion of the National Organization of Vascular Anomalies that all patietns that present with a hemangioma be evaluated by a physician experienced in the diagnsosis, classification and treatment of hemangioma and vascular malformations.  Please see our physician listing for a doctor near you.

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The treatment of a hemangioma can be complicated.  It is the position of NOVA that all patients diagnosed with a hemangioma or vascular malformation be evaluated by a physician experienced in the management of vascular anomalies. NOVA can assist you in finding a Vascular Anomaly Treatment Center or private physician to diagnose and treat vascular anomalies.

References

Bruckner, Frieden,  Infantile Hemangioma, Journal of American Academy of Dermatology  October 2006, vol 55, number 4 pp 670-682.

Congenital hemangioma and infantile hemangioma: missing links; John B. Mulliken, Odile Enjolras, Journal of American Academy of Dermatology, July 2004; 875-881.

NOVA PROVIDES THIS INFORMATION TO FAMILIES AS A RESOURCE. IT IS NOT INTENDED TO ENGAGE IN THE PRACTICE OF MEDICINE OR TO REPLACE THE PHYSICIAN. NOVA DOES NOT CLAIM TO HAVE MEDICAL KNOWLEDGE. NOVA DOES NOT ENDORSE ANY PARTICULAR PHYSICIAN, TREATING FACILITY OR TREATMENT PROTOCAL. IN ALL CASES NOVA AND ITS BOARD OF DIRECTORS RECOMMENDS THAT YOU SEEK THE OPINION OF A PHYSICIAN EXPERIENCED IN THE MANAGEMENT OF HEMANGIOMAS AND VASCULAR MALFORMATIONS. 

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