Hemangioma Treatment

There are several modalities of treatment used to manage hemangioma including medical management, laser, surgical excision, scelerotherapy and observation.

 

Medical Management:  There are several medications used to treat hemangioma.  Glucocorticosteroids have been used as the primary medical therapy for slowing and stopping the growth of a hemangioma.  Other medical therapies have included alpha2a-interferon, vincristine and most recently the beta blocker propranolol.  Interferon has been associated with serious side effect in children.  These risks must be carefully considered and weighed against the potential benefits of treatment.  Vincristine has generally been reserved for use in patients with endangering hemangioma.  Propranolol is new in the treatment of hemangioma.  While the medication is showing great promise careful controlled studies evaluating the potential side effects have not been completed.

In all cases medications have side effects, a careful discussion of all the risks and side effects should be take place before starting treatment with any medication.

Links to Medications to Treat Hemangioma

Laser:   Laser Therapy is used to treat superficial hemangioma and ulcerated hemangioma.  This method of treatment has been shown to be effective in treating hemangioma during he early growth phase, to help heal ulcerations and to improve the appearance of residual blood vessels after involution.  The type of laser used will depend on the phase of growth or involution of the hemangioma.

There are some known side effects of laser therapy.  Laser therapy may result in hypo-pigmentation of the area treated.  It can cause heating of the skin which may cause scarring.  It is very important to that the physician treating the child with laser is  experienced in the use of laser, the various types of laser and how they apply to hemangioma.

Laser is effective in decreasing the pigmentation of PWS and other vascular lesions. Laser is also effective in removing the small vessels that are left behind after a hemangioma has involuted.

Surgery:  Most infantile hemangioma do not require treatment.  When a hemancioma is causing ulceration, bleeding, functional impairment or a cosmetic defomrity is anticipated surgical treatment may be considered.  Surgical resection of a hemangioma, either to remove or debulk the hemangioma is advised for some patients.  Hemangioma near the eye that has not responded to steroids can be removed surgically to prevent loss of vision.  Removal of a large hemangioma may be recommended to reduce the emotional stress it has caused the child.  Ulcerated hemangiomas cause significant pain, and will often leave permanent scars.  Surgical removal of these hemangiomas will eliminate pain and reduce the scar.  Very large hemangioma may cause complications including high cardiac output failure, surgical removal or debulking will eliminate this complication. While  there are always risks to surgery, surgical removal of a hemangima can be performed with few complications and favorable outcomes.  As always the  risks must be carefully considered against the benefits of surgery

Embolization:rarely a procedure known as embolization or scelerotherapy is used to stop blood flow to a hemangioma.  Some physicians will have embolization done prior to surgery to lessen the risk of bleeding.

 

References:

Daramola OO, ChunRH, NashJJ, Drolet BA, NorthPE, Jensen, JN, KerschnerJE, Surgical treatmetn of infantile hemangioma in a multidisciplinary vascular anomalies clinic.  Int J Pediatric Otohinolaryngol, 2011 Jul29

Frieden, MD, Haggstrom, Drolet, Mancini, Friedlander, Boon, Chamlin, Baselag, Garzon, Nopper, Siegel, Mathes, Goddard, Bischoff, North, Esterly, Infantile Hemangioma: Current KNowledge Future Directions. Proceedings of a Research Workshop, April 7-9, 2005 Bethesda, Maryland, Pediatric Dermiatology Vol 22 No5, 383-406, 2005

Low David, Hemangiomas and Vascular Malformations, Seminars in Pediatric Surery Vol 3 No2 (May) 1994 pp40-61

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. 

 

Revised 2/24/2010

 

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