What is hemangioma?
Hemangioma is the most common type of vascular birthmark. It is a benign tumor of endothelial cells that form the inner lining of blood vessels.
Hemangiomas generally appear during the first weeks of life and grow rapidly for six to 10 months. Then they begin a much slower process of shrinking, or regressing, which may take from one to seven years. Finally, the tumor enters its final, shrunken state, after which it will not regrow. Tumor regression is complete in half of children by age 5 and in 70% of children by age 7.
How common are hemangiomas?
They are the most common benign tumor in infants. Between 4-10% of infants have at least one hemangioma. They are three to five times more common in females than in males and occur more frequently in Caucasian infants than in Asian -American or African-American infants. The incidence of hemangiomas may be as high as 24% in premature infants with low birth weight (fewer than 1000 grams).
What causes hemangiomas?
The exact cause is not known, although research is under way to better understand what triggers them. They usually are not hereditary, although 10% of infants have a family history of vascular birthmarks. No known food, medication, or activity during pregnancy can cause a hemangioma.
When do hemangiomas occur?
About a third of the time, the first signs are noticed while a child is in the hospital nursery; but the average age when the hemangioma appears is two weeks. These hemangiomas of infancy never develop in adults.
“Congenital hemangiomas” are rare vascular tumors that develop in the womb and are fully-grown at birth. They may regress rapidly called rapidly involuting congenital hemangioma (RICH) or they may not change called noninvoluting congenital hemangioma (NICH).
Where do hemangiomas occur?
About 60% of hemangiomas occur in the head and neck area, about 25% occur in the trunk, and 15% occur in the arms or legs. Most (80%) grow as a single tumor, while about 20% occur in multiple areas. If the baby has multiple hemangiomas, internal organs may also be involved.
What do hemangiomas look like?
The appearance of hemangioma depends on many factors, including whether it is near the surface of the skin or deep underneath; whether it is in the growing, shrinking, or shrunken stage; and whether it is the congenital type.
A tumor near the skin’s surface, called a superficial hemangioma, is usually raised, as a bright red patch. As it begins to shrink, the red color fades. Usually, the last traces of color are gone by the time the child is 7 years old.
The hemangioma that grows in the lower layers of the skin or in the muscle, called deep hemangioma, may appear bruise-like or bluish or may not be visible at all.
Congenital hemangiomas look different than the more common type that grows after birth. It is enlarged at birth, has a grayish cast with prominent veins, and may be encircled by a pale halo.
Can hemangiomas be prevented?
No. Nothing the mother does or does not do prior to or during pregnancy plays any role in whether her child develops a hemangioma.
When should a vascular anomalies specialist be consulted?
Since most hemangiomas are small (less than ½” diameter) and disappear on their own without any treatment, it is usually not necessary for a child to be seen by a specialist in vascular anomalies. The child should be followed by a primary care physician or pediatrician who monitors his or her condition and can contact a vascular anomalies specialist if needed.
There are exceptions. An infant should be referred to a vascular anomalies specialist if the diagnosis is unclear or if the hemangioma is large, growing rapidly, or ulcerates. Importantly, the infant or child should also see a specialist if the hemangioma may cause disfiguring complications. Also, a specialist should evaluate a child who has multiple hemangiomas in the skin, as this sometimes signifies that there is a hemangioma in an internal organ. Hemangiomas in the neck (the ‘beard distribution’) can involve the upper airway.
How are hemangiomas diagnosed?
Most hemangiomas are easily diagnosed by examining the child and correlating the physical findings with the medical history. An accurate diagnosis can be made in more than 90% of infants. If there is any uncertainty about whether a vascular birthmark is a hemangioma or a vascular malformation, ultrasonography or MRI (magnetic resonance imaging) usually provides a definitive answer.
If there is any suspicion of a malignancy (cancer), a biopsy should be performed. A biopsy involves removing a small section of tumor for microscopic evaluation.
What are the possible complications of hemangiomas?
While complications are uncommon, they occur in some children. Complications include ulceration (skin breakdown), which can bleed or become infected; obstruction of vital functions such as vision, hearing, or breathing; distortion of facial features; and, very rarely, internal bleeding or high output cardiac (heart) failure.
Ulcers, which may occur on the lip, cheek, or ano-genital region, can usually be effectively treated with topical antibiotics and frequent cleansing and dressings. They generally heal within a few weeks and do not recur, however, they may result in scarring that could require surgical treatment.
Hemangiomas that obstruct an airway or interfere with vision, hearing, or eating require prompt treatment with medication. Because of size or location, some hemangiomas can cause distortion of facial features, and should be treated with a drug during the growth phase to promote shrinkage and minimize the amount of remaining fat.
How are hemangiomas treated?
Most hemangiomas do not have to be treated because they go away on their own and leave behind almost normal skin. In some children, loose or discolored skin, or tiny, dilated blood vessels called telangiectasias may remain after the hemangioma has fully shrunk. When this occurs, surgical excision and/or laser therapy may improve the child’s appearance.
Some hemangiomas do require intervention, either because they are disfiguring or because they might endanger the child’s normal functions or life. These include hemangiomas that interfere with essential functions such as breathing, vision, or hearing; that bleed, ulcerate, or distort facial features.
The treatment options for a growing hemangioma include drug therapy and/or surgical excision. For some hemangiomas, such as eyelid tumors that do not respond to medication, or tumors that obstruct the airway, removal may be advised.