Pediatric Hemangioma and Vascular Malformations

Hemangiomas

A hemangioma is a type of birthmark. It is the most common benign (noncancerous) tumor of the skin. Hemangiomas may be present at birth (faint red mark) or may appear in the first months after birth.

A hemangioma is also known as a port wine stain, strawberry hemangioma, and salmon patch. About 60 percent of hemangiomas occur in the head or neck area. Hemangiomas occur at least three times more often in females than in males. Most will continue to grow for the first six to 12 months of life before beginning to shrink.

Hemangiomas can be:

• Capillary – forming on the skin’s top layer
• Cavernous – embedded in the skin’s deep layers

Hemangiomas have three stages:

• Proliferation – grows from a faint red mark to full size
• Resting – no change
• Involution – mark slowly disappears

The whole process can take up to several years.

Vascular Malformations

A vascular malformation is another type of birthmark, or congenital (present at birth) growth, made up of arteries, veins, capillaries, or lymphatic vessels.

There are several different types of malformations and they are named according to which type of blood vessel is predominantly affected. A vascular malformation is also known as lymphangioma, arteriovenous malformation, and vascular gigantism.

There are 5 types of vascular malformations. They are:

• Port wine stains (red or purple in color)
• Venous malformations
• Lymphatic malformations
• Arteriovenous malformations
• Mixed malformations, a combination of any of the other types

Hemangiomas and vascular malformations usually occur by chance. However, they can also be inherited in a family as an autosomal dominant trait. Autosomal dominant means that one gene is necessary to express the condition, and the gene is passed from parent to child with a 50/50 risk for each pregnancy.

In other words, a parent may unknowingly have had a hemangioma because it faded, but the child is more severely affected. The family may not come to the attention of a geneticist until the birth of the child with a more severe condition. Other relatives with mild expression of the gene are often discovered at that time, confirming autosomal dominant inheritance.

Hemangiomas and vascular malformations are a manifestation of many different genetic syndromes that have a variety of inheritance patterns and chances for reoccurrence, depending on the specific syndrome present.

Up to 12 percent of babies develop hemangiomas in the first year of life, and females are affected more often than males.

A physician is able to diagnose hemangiomas and vascular malformations after a physical examination. Sometimes a CT scan or an MRI is performed to determine the severity of the formations, and to what extent various structures are affected by them.

Most hemangiomas are not usually present at birth or are very faint red marks. Shortly after birth, however, they grow rapidly--often faster than the child's growth. Over time, they become smaller (involute) and lighter in color. The process of involution may take several years.

Vascular malformations are present at birth and enlarge proportionately with the growth of the child. They do not involute spontaneously and may become more apparent as the child grows.

Hemangiomas

Treatment for hemangiomas depends on their size, location and severity. Treatment is usually not recommended for small, noninvasive hemangiomas, since they will become smaller (involute) on their own. However, hemangiomas that cause bleeding problems, feeding or breathing difficulties, growth disturbances, or impairment of vision may require medical or surgical intervention.

Treatment may include the following:

• Steroid medications
• Embolization of the blood vessels (injection of material into the blood vessels to block the blood inflow)
• Laser or surgical removal

Vascular Malformations

Treatment for vascular malformations depends on the type of the malformation. Each type of malformation is treated differently:

• Capillary malformations - Laser therapy is usually effective for capillary malformations or port wine stains, which tend to be flat, violet or red patches on the face.
• Arterial malformations are often treated by embolization (blood flow into malformation is blocked by injecting material near the lesion).
• Venous malformations are usually treated by direct injection of a sclerosing (clotting) medication which causes clotting of the channels.

Most often, a combination of these various treatments is used for effective management of the lesion.

Many hemangiomas, depending on their size and severity, will go away without treatment. These conditions can be life-threatening if they’re large or affect your child’s airway or another organ. A hemangioma can also be serious if it has uncontrollable bleeding.

Depending on where your child’s growth is located, it may cause physical problems. Your child may have trouble seeing or moving part of their body.

Hemangiomas may grow until your child is about 12 months of age. Then they start to shrink and in many cases, they will go away without treatment.

Other hemangiomas need to be treated. These should be treated by a craniofacial healthcare provider. This is a specialist in diagnosing and treating head and face problems. Make sure your child’s provider has experience with hemangiomas.

Vascular malformations don’t shrink or go away without treatment. Your child should see a craniofacial specialist with experience in treating vascular malformations.

Noticeable hemangiomas and vascular malformations can cause psychological and social issues. Support groups can help you, your child and your family. Ask your child’s healthcare provider about support groups in your area.