hemangiomas

Infantile hemangiomas are a common occurence in pediatrics; a patient asked me to comment on them so here goes.  There are many terms for a similar set of lesions: capillary or cavernous hemangioma, hemangioma simplex, strawberry nevus or hemangioma or sometimes just plain “strawberry.” Long ago in her young childhood, my beloved niece, Lauren, called her few small facial marks her “cherries.”(ah, those were the days!!)

These lesions come in several forms including:

cavernous hemangioma of the cheek/lower eyelid

cavernous hemangioma of the cheek/lower eyelid

nodular hemangioma invloving the ear

nodular hemangioma invloving the ear

ulcerated hemangioma--note central tissue breakdown

ulcerated hemangioma–note central tissue breakdown

Hemangiomas are more common in females, with family history, in premature infants or pregnancies of older mothers.  80% appear on the upper 1/3 of the body.  They are typically not present at birth but rather appear in the first 3 months of life and grow in size over the next 1-18 months (80% have reached maximum size within 3 months).  Subsequently they mostly shrink away on their own (“involute”).  Central grey/white streaking or stippling is usually evidence that this process has begun.  Complete resolution can take as much as 10 years.  Lesions present at birth are called vascular malformations which are quite different and sometimes (but by no means frequently) associated with more serious problems.

In most instances, no treatment is necessary and these marks will ultimately go away completely on their own.  Despite their red, red/blue, and “juicey” appearance, when injured they tend to bleed no worse than regular skin.

Lesions require treatment if they are very large and particularly if >25% are “ulcerative”(tissue breakdown), block sensory organs or the airway, or persist into school age.  Larger lesions may need advanced imaging iike ultrasound or MRI.

Nowadays, when treatment is necessary, we use oral or topical propranolol, compression bandages,intra-lesional injections or oral steroids, and occasionaly lasers.

There are very unusual syndromes where these lesions are part of a constellation of abnormalities, like the “PHACES” syndrome, “PELVIS” syndrome, and POSSIBLY “Kassebach Merrit syndrome.”  In 30 years I have yet to encounter them.  I’ll keep looking , and hope I never find any.

I hope this is helpful.  Thanks for the inquiry. Please send along other questions or comments, and thanks for following.

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