Hemangioma

A hemangioma is an abnormal build up of blood vessels in the skin or internal organs. It is a benign self-involuting tumour of endothelial cells (the cells that line blood vessels). Hemangiomas are connected to the circulatory system and filled with blood. The appearance depends on location. If they are on the surface of the skin they look like a ripe strawberry, if they are just under the skin they present as a bluish swelling. Sometimes they grow in internal organs such as the liver ( hepatic hemangioma ) or larynx. In most cases, hemangiomas will disappear over time.

Hemangiomas are formed either during gestation or most commonly they are not present at birth but appear during the first few weeks of life. They are often misdiagnosed, initially, as a scratch or bruise but the diagnosis becomes obvious with further growth.

Hemangiomas are the most common childhood tumor, occurring in approximately ten percent of Caucasians, and are less prevalent in other races. Females are three to five times more likely to have hemangiomas than males. They are also more common in twin pregnancies. Approximately 80% are located on the face and neck, with the next most prevalent location being the liver. Although hemangiomas are benign, some serious complications can occur.

Types of hemangioma

Capillary hemangioma - Also known as Strawberry Hemangiomas since they have a red strawberry-like look. They are benign and composed of capillaries, and appear early in life (usually the first few weeks). They enlarge during the first year of life (thus causing worry) but stop enlarging by the end of the first year and start involuting. Each year they involute more and more such that by the age of 9 years 90% of them have disappeared.
Cavernous hemangioma - Appears in infancy and they persist. They are due deeper, more blood filled blood vessels and hence have a nodular purplish appearance but are completely benign. Biopsy is difficult and is avoided as blood is involved.

Stages of hemangioma

Hemangiomas go through three stages of development and decay:

1. Proliferation stage: Can last up to 12 months. A hemangioma grows very quickly.
2. Rest stage: Lasts until the infant is one to two years old. There is very little change in a hemangioma's appearance.
3. Involution phase: A hemangioma finally begins to diminish in size. 50% of lesions will have disappeared by age five with the vast majority gone by puberty.

Treatment

Most hemangiomas disappear without treatment, leaving minimal or no visible marks. Large hemangiomas can leave visible skin changes secondary to severe stretching of the skin or damage to surface texture.

When hemangiomas interfere with vision, breathing, or threaten significant cosmetic injury, they are usually treated. The mainstay of treatment is oral corticosteroid therapy. Other drugs are sometimes considered if the corticosteroids do not work. If this fails, surgical removal often becomes necessary.

Blockage of the airway will often require a tracheostomy to be performed (insertion of an external airway through the front of the neck into the trachea below the level of the obstruction).

Smaller raised lesions are sometimes treated with injection of corticosteroid directly into the lesion. Pulsed dye laser can be useful for very early flat superficial lesions if they appear in cosmetically significant areas or for those lesions that leave residual surface blood vessels in the case of incomplete resolution. Unfortunately raised lesions or lesions under the skin do not respond to laser.

Ulceration will usually heal with topical medication and special dressings under medical supervision. Sometimes pulsed dye laser can be used to accelerate healing.

Cost of Treatment

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Source: Wikipedia