Getting to know Vascular Anomaly Lesions (2): Hemangioma

What is hemangioma?

Hemangioma or also known as “strawberry mark” is a red lesion that is commonly mistaken as a birthmark. Lesions may appear within the first month – 2-4 weeks, after birth. These lesions that are medically called as infantile hemangiomas appear as elastic mass due to the excessive development of blood vessel on the skin and become one of the most common benign tumors in infants. Hemangiomas can appear on any parts of the body, but face, head, heck, chest and back are the most common parts affected.

Generally, hemangioma does not need specific treatment as it can heal spontaneously. Eventually, it will leave a scar after 5-12 years of time. However, if the lesion causes visual, respiratory, or any other functional impairment, then treatment of the lesion becomes necessary. Apart from infantile type, there is also the congenital type of hemangioma.

How many children suffer from it?

Approximately 4-5% of infants are born with hemangiomas.

What causes hemangioma?

The exact cause of hemangioma has not been clearly identified yet, but there are several possibilities; one of them is due to the excessive development of blood vessels which emerged into a collection of a solid yet elastic mass.

What are the risk factors of hemangioma?

Female infants are at greater risk compared to males (5:1 ratio). Also, premature births, low birth weight, and conditions of oxygen deficient pre-birth may also increase risks. Most of the cases occur sporadically even though some are genetically acquired.

What are the early signs and symptoms of hemangioma?

Lesion may start to appear as a flat red mark, red scratch, or as a bluish bruise. In the first month, lesions will become more apparent and grow faster up to the first year of age, which will develop into a solid, elastic, bright red colored mass on the surface of the skin. Lesions can also first appear as an insect or mosquito bite which then grow progressively. Lesions may appear bluish when it is located underneath the skin. Lesions may also appear on the mucous membrane, such as oral or eye mucosa.

How is the natural course of the disease?

Three phases are involved in the natural course of this disease. First phase is the rapid development, which occur for months. Lesions will keep growing until the age of 5–8 months or a year. During this phase, lesions can widen and occupy most area of the face, causing functional and aesthetic problems. Second phase is the deceleration or plateau which occurs at the age of 6–12 months. Involution is the third phase that occurs until the age of 5–12 years, leaving a more elastic lesion with color that has turned into purplish or grayish. Over time, this lesion will disappear, blending in with the normal skin color and leaving a scar or hypertrophic tissue.

How is the diagnosis confirmed?

Diagnosis is mainly confirmed based on clinical signs. Moreover, it can also be confirmed through a biopsy or radiography examinations, such as Doppler’s Ultrasound, CT scan, or MRI.

How to treat hemangioma?

Most of these conditions only need strict observations. However, in cases with functional organ impairments, treatments are required. Administration of propranolol is the first-line therapy. Other drugs, such as oral, intravenous, or topical corticosteroid (prednisone) can be used, as well as interferon and vincristine. Surgeries are done in lesions that impair critical functions, such as vision, or after involution phase. Other modalities, such as pulsed dye laser, can also be used as treatment.

What are the complications of hemangioma?

Hemangiomas can be wounded, develop bleeding, or causes infection and ulceration. Based on its location, hemangioma may affect organ functions, such as visual, auditory, respiratory, and excretory disturbances.

To be continued (3)

Written by Teddy Prasetyono, Ph.D. and Amila Tikyayala, M.D.

Division of Plastic Surgery, Department of Surgery

Dr. Cipto Mangunkusumo Hospital / Faculty of Medicine, Universitas Indonesia

Translated by Illona Andromeda, M.D.