Hemangioma

 Overview

Hemangioma is the most common benign vascular tumor in infants. It results from abnormal growth of endothelial cells that line blood vessels. Most are harmless and eventually regress without treatment.

Types

• Infantile Hemangioma:
  Appears within the first weeks of life, grows rapidly for 6–12 months (proliferative phase), then gradually shrinks over several years (involuting phase). By age 10–12, most completely disappear.

• Congenital Hemangioma:
  Fully formed at birth.

  • RICH (Rapidly Involuting Congenital Hemangioma)

  • NICH (Non-Involuting Congenital Hemangioma)

Incidence

• Occurs in 4–10% of infants.

• More common in girls, Caucasians, and premature or low-birth-weight babies.

• Rare in African-American infants.

Causes

Not hereditary and unrelated to maternal behavior during pregnancy. Likely caused by a mutation in a primitive endothelial stem cell during fetal development.

Location

• 60% on head and neck

• 25% on trunk

• 15% on limbs
  Can also occur internally (liver, GI tract, brain).

Appearance

• Superficial: Bright red, raised (“strawberry mark”).

• Deep: Bluish or under the skin.

• Congenital: Large, grayish, visible veins at birth.

Complications

Usually none. Possible issues include:

• Ulceration or infection (5–10%)

• Bleeding (rare)

• Obstruction of vision, breathing, or hearing

• Facial distortion or scarring

• Rarely, internal bleeding or heart failure (≈1%)

Diagnosis

Mostly clinical.
If uncertain, ultrasound, MRI, or CT may confirm diagnosis and extent.
Biopsy is rarely needed to rule out malignancy.

Treatment

Most require only observation.
Intervention needed for lesions that:

• Obstruct vital functions

• Ulcerate or bleed

• Cause severe disfigurement

Options include:

• Medication: Corticosteroids, vincristine, interferon

• Surgery: For airway, eyelid, or disfiguring lesions

• Laser: For residual redness or airway involvement (not for active tumor removal)

Prognosis

Most hemangiomas resolve naturally, leaving minimal marks. Cosmetic correction (laser or surgery) can be done before school age if needed.