Treatment1. First line therapy : systemic therapy with steroids or beta blockers solution/gel [Timolol] (still in clinical trials) Observation ("watchful waiting") with steroids during the proliferation stage to shrink the tumor and speed the involution process. Medical Rx : Indications:1. Mixed hemangiomas2. Proliferative hemangiomas3. Hemangiomas affects vital organs4. Life threatening hemangiomas• Oral CST.(prednisolone 3.0-5.0mg/kg body weight every morning for 6-8 weeks)• Efficacy is 84%
Treatment2. Small/Intermediate sized hemangiomas Rx- Imiquimod (immunomodifier) alternate day topical application.• Disadvg : hyperpigmentation3. Superficial proliferating hemangiomas/Hemangiomas at involution stage: Rx- Laser therapy + supplementary pharmacotherapy Choice of laser : Flash lamp-pumped pulsed dye laser Advtg : Selective destructions of B.Vessels,delivers photocoagulation to targeted vessels while keeping overlying skin intact.
Treatment4. Subcutaneous and deep-seated hemangiomas (>2cm & deep) a) Laser Rx: Neodymium;yttrium-aluminium-garnet (Nd:YAG) b)Percutaneous laser therapy. Effectiveness : 77-100% for smaller lesion. Side Effects :Tissue necrosis,scarring5. Localized Hemangiomas : (orbital,parotid region) Intralesional steroids: Triamcinolone (1-2mg/kg) at monthly intervals,depend on age of patient and size of the lesion.
Treatment• Intralesional steroids : Pingyangmycin (bleomycin A5) - specifically for hemangiomas based on high sclerosing effect on vascular endothelium. Efficacy: 90%,49% complete resolution. Indications :1. complicated cutaneous hemangiomas,2. proliferative hemangiomas responds poorly to steroids/laser therapy.• Hemangiomas unresponsive to steroids or rebound after steroids :1. Vincristine (0.5-1.0mg/kg given IV once a week over 6 weeks and then discontinued)2. Alpha-Interferon (not recommended except in cases which other drugs have been ineffective)
Treatment• Surgery : (Hemangioma Excision)• Aim : Remove or re-contour the residual deformity,scar,hypertrophied abnormality,hyperpigmentation or fibrofatty tissues to improve cosmetics and function.• Indications:1) Hg. located in the nose and lip that do not respond well to other Rx.2) Hg.in the eyelids that impair sight and aesthetics.3) Hg. occuring on the forehead and scalp.4) Repeated bleeding fr hg.5) Removal of residual deformities after conservative or laser therapy.
Treatment• The most commonly used technique for small lesions is very straightforward and involves removing the abnormal vascular tissue with a lenticular, or lens-shaped excision,that results in a linear scar. A ) – Strawberry Hemangioma at the right cheek. B) - The surgeon make incision around the mark C) - Suturing the skin around it.• http://www.surgeryencyclopedia.com/Fi-La/Hemangioma-Excision.html#b#ixzz2HPsWaR1g
Treatment• Larger, more extensive lesions may require angiography mapping of the vessel embolizationfollowed by complete removal.
Treatment•• Angiogram of parotid hemangioma, sequential from early arterial to late venous phase (A–D). From internal maxillary artery injection when performed at the time of planned endovascular embolization, it demonstrates dilated feeding arteries, organized gland-like arterial angioarchitecture with a dense parenchymal blush, and drainage into dilated adjacent veins.• http://www.sciencedirect.com/science/article/pii/S105251490700010X
Treatment• Aftercare for a hemangioma excision involves wound care and maintenance such as changing of bandages.
Treatment• For hepatic hemangioma, Kasabach Merritt Syndrome,incapacitating pain,compression adjacent organ and rupture are the only indication for surgical removal.• When it is indicated, enucleation should be the procedure of choice.• Liver transplant – (rare cases of diffuse hepatic hemangiomatosis,kasabach merritt syndrome)• Conservative nonsurgical approach is always advised.(analgesics) – liver resection presents with higher mortality/morbidity rates compared to natural course of the disease
References• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884763/• Treatment Guideline for Hemangiomas and Malformations of Head and Neck (Shanghai,China.& Arkansas Med. Science)• http://www.surgeryencyclopedia.com/Fi-La/Hemangioma-Excision.html#b• Surgical Treatment for Symptomatic Cavernous Hemangioma (Dept of Surgery,Ankara University School of Medicine,Turkey)