What is a hemangioma?
Hemangiomas are benign blood vessel tumors that occur in childhood. The most common type is the “infantile hemangioma” version (“strawberry mark”). Children are not born with these tumors typically. They appear in the first few days to weeks of life (can extend up to 6 months of age) as a faint red or pink blemish that can rapidly grow into a larger mass.
Types of hemangiomas
Hemangiomas come in two main varieties: infantile and congenital.
These types of hemangiomas are usually not present at birth, and they start growing after birth. They look red and grow rapidly. Subtypes of infantile hemangiomas are:
- Superficial Hemangiomas, or “strawberry” hemangiomas, appear as bright red tumors.
- Deep Hemangiomas can appear under or on the skin that may appear normal or have a bluish hue.
- Mixed Hemangiomas have both superficial and deep components.
- Nodular hemangioma is the most common form. They are discreet and oval or round. Besides, these hemangiomas tend not to have a connection with malformations.
- Large hemangiomas with characteristic geographic shapes that span a wide area of the body can be a sign of greater complications and underlying developmental issues.
Prenatal ultrasounds can detect hemangiomas, which are vascular lesions that have developed in the uterus and are present at birth. These lesions usually appear round or oval and may be pink, purple, or a mixture of colors. Additionally, the skin growth is usually raised and warm to the touch.
A physical examination and review of the patient’s history are typically all that is necessary for diagnosing these vascular malformations. If there is an underlying lesion, an ultrasound or MRI can identify it further.
Hemangiomas may, though rarely, be linked to other syndromes. To determine such a connection, it is possible that further evaluation and testing.
What are the options for hemangioma treatment?
Most hemangiomas, being of the “infantile” variant, require no specific intervention. Over time, the hemangioma will initially increase in size, then plateau, and continue on to involution. Often, the entire hemangioma will disappear at the end of this process with no residual signs that it was ever there.
Sometimes, hemangiomas may require treatment. This is true of large hemangiomas, those that cause visible disfigurement, ones that have failed to involute completely, or those that can obstruct vital functions such as vision or breathing. In these cases, treatment can take the form of medication or surgery.
Treatment is necessary if there are :
- Ulceration. Hemangiomas can lead to skin breakdown, which is often painful and can cause permanent scarring. Areas like body folds, diaper regions, and lips are most vulnerable to ulceration.
- Impairment of vital functions. Depending on their size and location, hemangiomas can impact important functions such as sight, breathing, and eating. For instance, hemangiomas in the eyelid can prevent normal eyesight development. A surgeon must address them immediately.
- Risk of permanent alteration to appearance. If a hemangioma is on the face or in other easily visible places, treatment may be necessary, as it may cause permanent changes to the skin or develop into a fibrofatty mass.
Localized Treatment Options
- Timolol, a type of topical beta-blocker, can also treat hemangiomas.
- Although a topical steroid may be helpful, the use of timolol has become more popular than in previous years.
- Steroid injections into the hemangioma can be a beneficial form of treatment.
- A topical wound care routine can aid in the treatment of ulcerated hemangiomas.
Systemic Treatment Options
- Oral beta-blockers are currently the most widely used form of treatment for hemangiomas that require systemic therapy. Propranolol, which has been in use for several years to treat hypertension, has gained FDA approval for the management of hemangiomas. Side effects may include drops in heart rate, blood pressure, and blood sugar; that is why close monitoring by a medical professional is requisite.
- Although they are not as widely used as oral beta blockers, oral steroids may still be beneficial in certain instances.
Other Treatment Options
- Laser treatments can be beneficial for treating ulcers in hemangiomas and lessening any remaining redness after involution.
- When a child is between 3 and 4 years old, a surgical procedure can be a great way to remove and repair any residual tissue that may remain after involution. In certain cases, your surgeon may recommend earlier surgical intervention.
Why choose Dr Panossian
- He received his medical education at Tufts University School of Medicine.
- Graduated at the top of his class at UCLA, receiving Phi Beta Kappa and Summa Cum Laude honors.
- Was accepted into an elite combined general surgery and plastic surgery residency at the Keck School of Medicine of USC.
- Completed subspecialty training in craniofacial surgery at the Hospital for Sick Children in Toronto and Harvard Medical School.
- Was mentored by Dr. Ron Zuker in the practice of facial paralysis reconstruction. This prestigious fellowship position was available to only one surgeon in the United States.
- Is affiliated with various charitable and educational organizations, including Operation Smile and Mending Kids.
- Is a member of the American Society of Plastic Surgeons and the highly selective American Association of Plastic Surgeons, reserved for only a select group of individuals nationally who have demonstrated excellence in academic plastic surgery.
- Holds memberships in several other professional societies including the American College of Surgeons and the American Society of Reconstructive Microsurgery.
- He serves on the Board of Directors for Mending Kids and the Gondobay Manga Foundation, a non-profit organization dedicated to the improvement of lives in Sierra Leone.
- Has been nominated by his peers annually since 2012 as a “Super Doctor.”
- Served as an expert medical consultant and appeared on The Doctors, Grey’s Anatomy, and Nip/Tuck.
- Has been featured as “Top Doctor” in US News and World Report, Pasadena Magazine, and Los Angeles Magazine.
Last modified by Dr. Andre Panossian