What are hemangiomas

Hemangiomas are the most common type of vascular birthmark in infants and children, consisting of immature blood vessels. They are the most common benign (non-cancerous) tumor found during the first year of life.

Hemangiomas are categorized into infantile hemangiomas and congenital hemangiomas. These categories are based on when and how they grow.

• Congenital hemangiomas develop in utero and are present at birth. These include:
  • Rapidly involuting congenital hemangioma (RICH): This type of hemangioma grows in utero, is present at birth, and often shrinks rapidly during the first year of life.
  • Noninvoluting congenital hemangioma (NICH): These hemangiomas do not shrink and are most commonly treated by surgical excision.
• Infantile hemangiomas are the most common type of hemangioma and usually appear during the first few weeks of life. They will generally grow during the first year of life, then shrink slowly over the next several years.

Current treatment options for hemangiomas focus on limiting the growth of the hemangioma and promoting shrinkage.

Symptoms

Hemangiomas can take on a different appearance depending on the location of the birthmark.

• A strawberry hemangioma is an abnormal collection of blood vessels in the skin. Because it is superficial (on the surface of the skin), it has a bright red color and well defined border.
• Hemangiomas located in the layer of fat beneath the skin have a bluish, lumpy appearance. Previously called cavernous hemangiomas because they were thought to contain larger blood-filled vessels, these are actually quite similar to strawberry hemangiomas, and their blue color is because of their deeper location under the skin.
• A mixed hemangioma is located in both the skin and the fat layers, and can take on a similar appearance to both types explained above.

Infantile hemangiomas will typically grow and change appearance during the first 6 to 12 months of life. At birth, your child may have a faint red or pink mark, but these birthmarks generally become larger and more noticeable during the first year. They can also become raised lumps. After that first year, they generally shrink over the next several years.

Evaluation and diagnosis

Because hemangiomas grow rapidly during early infancy, they can cause a variety of health problems related to where they are located.

Those near the eye can cause problems with the development of normal vision. Those around the mouth or in the airway can cause breathing issues. Hemangiomas on the nose and ear can cause damage to the underlying cartilage and may distort adjacent tissues. Ulcerations or bleeding may arise on hemangiomas, especially when they are present on the lips, cheeks and genital areas. Ulcerated hemangiomas will leave permanent scars on the skin. Large hemangiomas on the face may be associated with multiple developmental health issues.

Depending on these factors, additional studies may be performed to help your doctor understand the extent of the condition and determine the best treatment plan. These tests might include blood tests, an electrocardiogram, ultrasound exam or magnetic resonance imaging (MRI).

If your child is an infant and the hemangioma is large, affecting the eyes, nose, lips or ears, or becomes crusted or ulcerated, we recommend you see a specialist. Depending on where the hemangioma presents and what kinds of symptoms are associated with it, your child’s initial evaluation may be through dermatology, gastroenterology, ophthalmology, otolaryngology or plastic surgery.

Your child’s primary care physician can fill out an expedited appointment request to help us schedule your child sooner.

Treatment

Many hemangiomas do not need to be treated. However, you should seek medical care if the mark is ulcerated, interfering with your child’s vision, causing breathing problems, or is very large and disfiguring.

Children with hemangiomas are treated by a multidisciplinary team of specialists through the Infantile Hemangioma Program. The team brings together experts from Children’s Hospital’s Dermatology Section, Plastic Surgery, Oculoplastic Surgery and Interventional Radiology.

Depending on the location and extent of your child’s hemangioma, treatment may include medication, pulsed dye laser therapy, or surgical excision.

• Medication may be used to slow down the growth of blood vessels in the hemangioma. In some children, medication can help the hemangioma to decrease in size.
• Pulsed dye laser therapy targets the abnormal blood vessels but does not affect the normal skin and tissue nearby. While it may not go deep enough into the skin to eliminate a hemangioma, this laser can fade the large blood vessels and keep the hemangioma from growing. It may also help to heal an ulcerated hemangioma and reduce its discomfort. This treatment keeps scarring to a minimum and is safe at any age.
• Surgical excision may be recommended for hemangiomas that are interfering with function or normal development, or that have not shrunk enough and are still large and disfiguring. In addition, noninvoluting congenital hemangiomas usually require surgical excision.

Your child’s medical team will work with your family to determine the best treatment approach for your child.