Hemangioma

 Hemangioma

Birthmarks come in all shapes and sizes. A hemangioma---- once known specifically as a strawberry hemangioma---- is a birthmark that appears as a bright red patch or a nodule of extra blood vessels in skin. It grows during the first year of life and then recedes over time. A hemangioma is usually benign and isn’t associated with other medical conditions.

Symptoms

·          A hemangioma, which is sometimes referred to as infantile hemangioma, may be present at birth or appear during the first several weeks of life. It starts out as a flat red mark anywhere on the body, most often the face, scalp or back of the neck.

·          During first year of life, the red mark becomes a spongy mass that protrudes from the skin----often growing rapidly up to 2 or 3 inches (about 5 to 7.5 centimeters) in diameter. The hemangioma then stops growing and enters a rest phase. Eventually, it begins to slowly disappear.

·          Half of all hemangiomas resolve by age 5, and nearly all hemangiomas are resolved by age 10. Although the color of the birthmark also fades, faint---- but permanent---- discoloration of the skin or residual extra skin may remain.

o    30% resolve by the child’s 3rd birthday; 50% resolve by the 5th birthday and 70% of hemangiomas resolve by the 7th birthday

Causes

·          A hemangioma consists of an abnormally dense group of extra blood vessels. It’s not clear what causes the blood vessels to group together, although some research suggests a link between hemangiomas and certain proteins produced by the placenta during pregnancy.

Complications

·          Ulceration is the most common complication. It may lead to pain, infection, bleeding scarring, may interfere with sleeping/feeding habits

o    Early white discoloration can be a clue that the lesion is going to ulcerate

·          Hemangiomas in general may block vision, affect feeding/breathing/ hearing. (recall- most have a benign course)

·          Locations with unique risks

o    Periorbital area

§   May cause refractive errors, astigmatism, strabismus, ptosis, stimulus deprivation ambloyopia. Permanent visual deficits

o    Pelvic/Perineal areas

§   May be associated with urogenital/anorectal anomalies (hypospadias, imperforate anus, atrophy or absence of labia minora)

§   Likely to ulcerate and become infected due to friction and chemical trauma

o    Lumbosacral

§   May be associated with spinal anomalies (occult spinal dysraphism, tethered spinal cord, lipomeningomyelocele) 

§   US and MRI are warranted in infants with hemangiomas overlying the midline of the lumbosacral region

o    Facial

§   Most common location for hemangiomas of infancy (head/neck)-60% of cases

o    Lip/oropharynx/nasal tip/ears

§   May incompletely involute

§   May require surgical intervention to minimize scarring and deformity

o    Preauricular

§   May involve the parotid gland

§   Do not usually compromise the facial nerve

o    Diffuse facial

§   Tends to be in a segmental distribution (frontonasal, maxillary or mandibular)

§   More likely to ulcerate

§   Increased likelihood of visceral hemangiomas (liver, GI tract, brain)

o    PHACES syndrome

§   Large facial segmental hemangiomas in association with visceral hemangiomastosis meet criteria

·          Posterior fossa brain malformation, multiple Hemangiomas, Arterial anomalies such as coarctation of the aorta, Cardiac defects, Eye abnormalities

o    Beard distribution (preauricular, chin, lower lip, anterior neck)

§   Associated with laryngeal or subglottic hemangiomas that may RAPIDLY compromise airway

o    Laryngeal and subglottic

§   May cause stridor, persistent cough, hoarseness, respiratory distress, cyanosis

§   Many will present with respiratory symptoms between 6-12 weeks of life

§   NEEDS xrays, MRI, or laryngoscopic visualization to determine extent of involvement

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