Dermatology Facts—Hemangioma of Infancy

Hemangioma of infancy is a common benign tumor that is composed of increased numbers of blood vessels. Although only 1 to 2.6 percent of newborn infants have hemangiomas present at birth, they are found in up to 10 percent of patients by 1 year of age, and appear most frequently during the first four weeks of life. Hemangiomas may have different appearances, depending upon the depth of the increased numbers of blood vessels. More superficial hemangiomas tend to be bright red and elevated with an uneven surface. Deeper hemangiomas tend to be smooth on the surface, but blue in coloration. Many times, both red and blue components will be present. Not infrequently, the more superficial types of hemangiomas will begin as flat, pink areas, or even look like a bruise or scratch at birth, and then rapidly change into the elevated, bright red lesions.

Hemangiomas typically tend to enlarge in size between 1 month and approximately 8 months of age, then reach a plateau and begin to resolve most extensively between 1 and 3 years of age. Approximately 50 percent of hemangiomas have involuted by 5 years of age, and 90+ percent by 9 years of age, with continued involution until 12 years in occasional cases.

Because of the natural history of eventual resolution of these lesions and the potential side effects of available treatment agents, we only intervene if there is a reason to. Indications for intervention include ulceration (breakdown of the skin), problems with vital functioning, including eating effectively, vision, hearing and breathing, and when the hemangioma is growing so rapidly and large, that there is a high risk of leaving permanent scarring. The most common means of intervention are systemic, intralesional, or topical cortisone, laser, and excisional surgery. The choice to use one of these various techniques involves the location, age and appearance of the lesion. Children with hemangiomas that may cause problems must be followed closely. For many children, only ongoing intermittent observation of these changing hemangiomas by your doctor is most appropriate. Photographs to monitor growth and involution can be very helpful in management.

Unfortunately, if the hemangioma is in a visible location, you will probably be bombarded with questions or even rude comments from strangers. You need to find an approach to help cope with these comments. Discuss this with your family and doctors. It is very important that the child be treated as a normal child in as many respects as possible.

Excellent information regarding hemangiomas and other vascular birthmarks can be obtained from the Boston Children’s Vascular Anomalies website by going to the Children’s Hospital website (www.childrenshospital.org) and searching under "vascular anomalies."