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PATIENT STORY

A baby girl is brought to the office because her mother is concerned over the growing strawberry hemangioma on her face. Her mother is reassured that most of these childhood hemangiomas regress over time and that there is no need for immediate treatment (Figure 115-1).

FIGURE 115-1

Strawberry hemangioma on the face causing no functional problems. Treatment is reassurance and watchful waiting. (Reproduced with permission from Richard P. Usatine, MD.)

INTRODUCTION

Hemangiomas are the most common benign tumors of infancy, affecting approximately 5% to 10% of children with Caucasian ethnicity.1

Up to 70% of hemangiomas are small and of cosmetic concern only and will resolve at the predictive rate of 10% per year, that is, 50% will have involuted by age 5; 90% by age 9.2

Segmental morphology, large size, and location on the face are predictive of poorer outcomes as measured by complication rates and suggest the need for further investigative study.3

SYNONYMS

Infantile hemangiomas, angiomas. Strawberry hemangiomas are also called superficial hemangiomas of infancy. Cavernous hemangiomas are also called deep hemangiomas of infancy.

EPIDEMIOLOGY

  • Approximately 30% of hemangiomas are present at birth; the other 70% appear within the first few weeks of life.

  • Although the most predictive condition involving infantile hemangioma is low birth weight, other factors to be considered are prematurity, fair-skinned infants, female sex (2.4:1), and even in some cases family history.1,4

  • In one study, the mothers of children with hemangiomas are of higher maternal age, have a higher incidence of preeclampsia and placenta previa, and are more likely to have had multiple-gestation pregnancies.5

ETIOLOGY AND PATHOPHYSIOLOGY

  • Hemangiomas consist of an abnormally dense group of dilated blood vessels.

  • Hemangiomas are characterized by an initial phase of rapid proliferation, followed by spontaneous and slow involution, often leading to complete regression.

  • Vascular malformations do not exhibit rapid proliferation but rather grow in proportion to the child and are considered a separate and distinct diagnosis with differing treatment regimens.

  • Most childhood hemangiomas are small and innocuous, but some grow to threaten a particular function or even life.

  • Rapid growth during the first month of life is the historical hallmark of hemangiomas, when rapidly dividing endothelial cells are responsible for the enlargement of these lesions. The hemangiomas become elevated and may take on numerous morphologies (dome-shaped, lobulated, plaque-like, and/or tumoral). The proliferation phase occurs during the first year, with most growth taking place during the first 6 months of life. Proliferation then slows and the hemangioma begins to involute.

  • The involutional phase may be rapid or prolonged. No specific feature has been identified in explaining the rate or completeness of involution. ...

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