They occur more often in Caucasians and are less likely in Asian infants. Hemangiomas occur more often in premature infants and have a higher incidence in multiple gestation births. (twins) Premature and infants weighing less then 2.2 pounds, have an incidence of hemangioma of nearly 3 times more then full term infants. This data provides interesting trends and leads to questions that will direct research in t he future however; there is no known cause for a hemangioma .
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. There is not a known correlation between hemangiomas which occur on the skin and internal hemangioma.
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. This first appearance is called a "precursory lesion". Most hemangiomas develop during the first few weeks; they are rarely full grown at birth . Those hemangiomas that develop in the first weeks of life are called Infantile Hemangioma . Hemangiomas that are fully developed at birth are called Congenital Hemangioma. Hemangiomas are classified as either superficial, deep or combined superficial & deep. Traditionally hemangiomas were called strawberry birthmarks or cavernous hemangioma today physicians experienced in the diagnosis and treatment of vascular lesions prefer the superficial or deep classifications. "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 may be called "Combined Superficial & Deep" . Recently there has been a newly described classification of hemangioma listed, "Segmental" , this type of hemangioma is characterized by a large flat or slightly raised Hemangioma often seen on the face. Segmental Hemangiomas typically grow rapidly and are more difficult to treat. The classification of a hemangioma is based on the published work of Dr. John Mulliken of Boston Children's Hospital in the 1980's. The classification system continues to evolve as the understanding of hemangioma deepens.
Infantile Hemangiomas will typically grow for 9-12 months; some may grow up to about 18 months This is called the "growth phase" of a hemangioma development. After completing the growth phase a hemangioma will plateau and then enter into a spontaneous regression period. This is call "involution . " Some hemangiomas involute slowly and others involute rapidly. Those that involute rapidly often will leave little to no evidence that a hemangioma was ever present. Hemangiomas that involute slowly, taking >5 years are more likely to leave residual scaring in the forms of fibro fatty tissue, small blood vessels and other scarring. While all Hemangiomas eventually involute the result is not always cosmetically acceptable. Evaluation by an experienced physician can help to determine if a hemangioma should be treated or to be allowed resolve naturally.
Most hemangiomas do not result in significant complications for the patient. However; those that are considered complicated hemangiomas can have endangering complications including, pain, ulceration, infection, structural abnormalities, and interference with breathing, vision and hearing. According to the American Academy of Dermatology, hemangiomas of infancy should be evaluated for these complications and treated accordingly. The treatment for complicated hemangiomas include; medical management including steroid injections, oral steroids, other pharmacological treatments like Vincristine, laser and surgical excision.
The psychological implications of facial disfigurement should not be ignored in the management of facial hemangioma. In a culture where “fitting in” seems to be more important then ever, Parents should consider that children become socially interactive at age 2-3 years of age. Children are teased by their peers for wearing the “wrong” colored socks, imagine the implications for the child with a facial difference resulting from a hemangioma. Many physicians will advocate treatment with the goal of restoring a more normal appearance to the facial difference in time for school. Since many children are in preschool at very early ages families may want to discuss earlier intervention to account for earlier school settings. Some families seek resolution surgically at a very young age due to the individual family dynamics. Early intervention by an experienced physician may minimized the disfigurement and decrease the risk of psycho/social concerns, these issues need to be discussed in the context of the overall long term benefits to the child.
In rare instances “hemangiomas” have been associated with life-threatening complications. Usually these lesions are very large, greater the 5cm X 5 cm of surface area. This type of lesion may interfere with eating, breathing, vision, hearing and speech. In fact these lesions are not actually hemangioma but are called Kaposi Form Hemangioma Endothelioma and Tufted Angioma. These two types of vascular anomaly are also associated with complications leading to clotting abnormalities, (thrombocytopenia or Kasa Bach Merritt Syndrome) and congestive heart failure. Although these lesions are not actually a hemangioma they are often first diagnosed as one. Children with more then 4 hemangioma of the skin are at risk for internal hemangioma of the liver, airway, brain or digestive track. Internal hemangioma or visceral lesions are often difficult to detect. There is not a full understanding of the correlation between hemangioma of the skin and internal or structural hemangioma. A child with an internal hemangioma may show signs of jaundice, blood in the stool, croupy cough or difficulty breathing (stridor). Ultrasound or MRI may be performed to rule out internal hemangioma in children with multiple skin lesions or other symptoms.
The treatment of a hemangioma can be complicated. It is the position of NOVA that all patients diagnosed with a hemangioma or vascular malformation be evaluated by a physician experienced in the management of vascular anomalies. NOVA can assist you in finding a Vascular Anomaly Treatment Center or private physician that accurately diagnose and treat vascular anomalies.
NOTES:
1. According to the the most recent data complied by the Hemangioma Investigative Group and presented at the April 2005 workshop: Infantile Hemangioma Current Knowledge & Future Directtions, National Institute of Health, Bethesda, MD the actual incidence of infantile hemangioma ranges from 4-10% based on referral to a medical specialist. It is thought that the variation in numbers is biased based on the reporting by referral.
** NOTE** Hemangioma and Vascular Malformations may be associated with other serious diseases and syndromes. It is important to have all vascular anomalies evaluated by a physician. |
