Read our patient story, Samantha has a Hemangioma
The most common vascular birthmark is a hemangioma, which is a type of benign (non-cancerous) vascular tumor seen in infants. Hemangiomas typically appear within a few days to weeks of the infant’s life and then grow rapidly. This is known as the “proliferative phase” and usually lasts for six months to a year. Then the tumor enters into the “involuting phase” which is the slow shrinking of the hemangioma. Most hemangiomas regress, or get smaller, without any intervention. This phase can last 10 years. Hemangiomas may leave behind scarred or saggy skin when they involute. If the hemangioma is not significantly smaller and less noticeable by the time the child is of school age, treatment may be considered to reduce psychological impact.
Hemangiomas represent a localized growth of abnormal endothelial cells. These are the cells that normally line the inside of blood vessels. Hemangiomas can vary in appearance depending on location. If they are on the surface of the skin, they can have a bright red “strawberry” textured appearance. If they are under the skin, they often look like a bruise or bluish swelling.
Children with three or more hemangiomas need to have an ultrasound evaluation to look for any internal lesions. Large hemangiomas should prompt a search for other types of problems. They can be associated with vascular malformation syndromes such as PHACE, Klippel-Trenaunay, or Sturge-Weber syndromes. If children with multiple hemangiomas or large hemangiomas are not growing and gaining weight as expected, or are not reaching their developmental milestones, they should be seen by a multidisciplinary vascular birthmark team.
There are a few special types of hemangiomas which are different than described above. In some cases, a fully formed lesion is present at birth. These “congenital hemangiomas” may not have a growth phase, and may involute rapidly. Some congenital hemangiomas will never involute and require surgery. Any hemangioma that does not follow the typical growth pattern should be evaluated by the vascular birthmark team.
Small localized hemangiomas can often be treated with surgery. Medications such as corticosteroids, beta blockers, or chemotherapeutic agents are used for complicated or large lesions.