NOVA patient prior to treatment with Dr. Milton Waner's team.

     In order to understand how hemangioma is treated you first must consider the unique natural history a hemangioma presents. Untreated all hemangioma will involute, however some will cause functional impairment and psycho-social concerns. After involution is complete many will leave residual scarring in the form of fibro fatty tissue, telangiectases and other skin irregularities. How hemangiomas are treated is therefore individualized. The location, potential for complications, size, age of the patient and rate of growth must be considered and weighed against the risks and benefits of treatment.

Evaluation for the treatment of hemangioma can best be accomplished in a multidisciplinary setting, where physicians from different areas of medicine evaluate and determine how to manage the individual patient.  These centers are often called Vascular Anomaly Treatment Centers or Hemangioma and Vascular Malformation Centers.  In a multidisciplinary setting, physicians will manage the patient by considering several important issues. They will consider if the hemangioma presents any life-threatening or function compromising complications. They will evaluate the hemangioma for ulceration, bleeding, infection and pain. They will consider the risk of scarring or permanent disfigurement after involution is complete and examine the psychosocial distress on the patient and the family unit. Up until recently uncomplicated hemangiomas were “observed” This practice was based on research information from as far back as 1928, and was in large part due to the fact that there was no dictable treatment option available to physicians. It was hoped that most lesions would involute (become smaller) on their own. With the advent of multidisciplinary clinics more investigation is being made into the treatment modalities used in treating hemangiomas. Clinicians agree that there are some general indications for treatment of hemangioma. Life- threatening hemangioma and those that are causing impairment of vision, hearing, airway or are at risk for liver involvement, heart failure or respiratory compromise. There are certain anatomic locations that are known to leave permanent deformity, and therefore should be treated. Hemangiomas located on the nose, lip and ear or large facial hemangiomas with ulceration are known to leave permanent scarring or disfigurement. Patients with lesions meeting these criteria should be evaluated for the best course of treatment.

According to the American Academy of Dermatology's Guidelines for the care of hemangioma of infancy , treatment should be based on risk. The risk categories include low-risk hemangioma, those that are causing no functional impairment and those that are unlikely to leave permanent disfigurement and high-risk hemangioma, large hemangioma, causing functional impairment, involving extracutaneous structures or those likely to leave permanent disfigurement. Low-risk hemangiomas are typically treated with topical or intralesional corticosteroids, flash-lamp or pulse dye laser, or surgical excision. High risk hemangiomas are generally treated more aggressively. Systemic (oral) corticosteroids of doses from 2-5 mg/kg, pulsed dye laser, surgical resection and debulking and combined therapies. In rare cases hemangiomas do not respond to the standard methods of treatment. In these cases other medical modalities such as the use of interferon, vincristine and other anti-angiogenic agents are used.

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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