Hemangioma is the most common benign tumor of infancy and children. These tumors are noncancerous blood vessel cell tumors involving endothelial cells. Endothelial cells normally line blood vessels. In the classification of vascular anomalies there are two types of hemangioma identified.
Infantile Hemangioma and Congenital Hemangioma
Infantile Hemangioma is the most common type of hemangioma. (IH) These lesions are reported to occur in 4-10% of infants. They are 3-5 times more likely to occur in females then males. They are more common in Caucasian infants then Asian or African American infants. Premature infants have a much greater incidence of infantile hemangioma then full term infants. Infants with a birth weight of less then 2 pounds or 1,000 grams have a reported incidence of hemangioma of 255. Hemangioma is also more commonly noted in multiple gestation. (twins)
A infantile hemangioma often appears as a small red spot or discoloration of the skin at birth or within the first 2 weeks of age. Most of these lesions grow over the next year, some grow very rapidly. The process of growth is known as proliferation. After a hemangioma completes the growth phase it will begin a process of spontaneous regression known as involution. The process of involution is unique to hemangioma. Involution may take one to ten years to complete. It has been reported that 50% of hemangioma will complete involution by age 5 and 70% by age 7. By the time a child reaches 10 years of age involution is complete. A fully involuted hemangioma may leave behind residual scaring in the form of fibro-fatty tissue, loose skin with visible veins and scars due to prior ulceration. Once a hemangioma has involuted it will never re-grow.
In race occurrences a hemangioma may be fully formed at birth. This type of hemangioma is called a Congenital Hemangioma.
•· Rapidly involuting congenital hemangioma- RICH
•· Non-involuting congenital hemangioma-NICH
•· Partially-involuting congenital hemangioma-PICH
The exact cause of a hemangioma is not known. They are most often not hereditary although sometimes children with a hemangioma also have a family history of vascular anomalies. It is not believed that any behavior or activity causes a hemangioma. No food, medication or activity during pregnancy is associated with a higher risk of hemangioma.
Many Vascular Anomaly research teams are researching the cause of hemangioma. There are many theories. There is evidence that a random mutation in a very early cell in the developing fetus (stem cell) results in a hemangioma.
Hemangioma Varies in location
Hemangiomas occur on the head and neck between 70 -80% of the time. Approximately 20% appear throughout the rest of the body. They can occur internally and externally. Hemangiomas vary in size and shape. Some are very small and present not medical or cosmetic concerns while others are large, disfiguring and present medical concerns. Most hemangioma occur in the skin. However they may develop internally, on any organ including the liver, gastrointestinal tract and brain.
Hemangioma Varies in Size and Shape
When a hemangioma first appears it is often small and can be either bluish or reddish. It may be a small raised spot or a flat patch. Most hemangiomas grow during the first few weeks; it is rarely full grown at birth. In the early stages some appear either as bluish or reddish spots or flat patches. Rarely is a hemangioma fully grown at birth. “Superficial” hemangiomas are flat and red those that are deep beneath the skin and appear blue in color are called “Deep” hemangiomas. Hemangiomas often have both superficial and deep components; they are called “Compound”. A congenital hemangioma looks very different from most infantile hemangioma. They are fully formed at birth and often have a gray tint to them. They can be round or oval and will often have prominent veins visible through the skin.
How a hemangioma looks depends on many things. If the hemangioma is superficial it will look very different from a deep hemangioma. Hemangiomas change during the growth and involution phases.
Nothing a mother does or does not do can prevent a hemangioma.
Most hemangiomas are without complications. However, there are some serious complications that can occur in some children.
Ulceration: The most common complication of a hemangioma is Ulceration. Ulceration is a breakdown in the skin. When the skin breaks down the hemangioma may bleed, is at risk for infection and is very painful. Medical literature reports that 5-10% of hemangioma ulcerate. Often the ulceration occurs in on the lip or genitalia. However; an ulceration may occur in any hemangioma. Ulceration is may be effectively treated with topical antibiotics, clean dressings and pain management. Sometimes oral medications, laser or surgery is needed to treat the ulceration. Bleeding may be controlled with direct pressure.
Obstruction: Hemangiomas may also obstruct vision, hearing or breathing. Hemangiomas occurring on the face may cause significant facial differences. Hemangiomas that obstruct the vision, airway or eating require treatment. Hemangioma in the eyelid should be promptly evaluated by a pediatric ophthalmologist- delay can result in permanent loss of vision.
Some hemangiomas grow very large. Large hemangioma of the face may result in facial disfigurement. The psychological implications of facial differences should be considered in managing these children.
Very rarely a hemangioma will result in internal bleeding or high cardiac output failure.
Some hemangiomas require intervention by a physician or a vascular anomaly team of physicians. According to the American Academy of Dermatology infants with hemangioma that are obstructing vision or breathing, have ulcerated or bleed or have the potential for facial disfigurement require medical intervention.
There are several modalities of treatment used to manage hemangioma including medical management, laser, surgical excision, scelerotherapy and observation.
Mulliken, Glowacki J (1982) Hemangioma and Vascular Malformations in infants and children. A classification based on endothelial characteristic. Plast Reconstr. Surg 69:412-422
Haggstrom, Drolet, Baselga, Chamlin, Garzon, Horii, Lucky, Mancini, Metry, Newell, Nopper, Frieden, Prospectiv Study of infantile hemagniomas:dermgraphic, prenatal and perinatal characteristics. J Pediatric. 2007 Mar;150(3):2911-4
Frieden, Enjolras, Esterly, Vascular Birthmarks and Other Abnormalities of Blood Vessels and Lymphatics, Chapter 20pp 834-862,