2.
An infantile hemangioma is also called “strawberry
mark”. This is a very common type of birthmark
made of blood vessels. These are benign vascular
neoplasms that come about by uncontrolled growth
of endothelial cells
These lesions are usually not detectable at birth but
appear during the first 4 to 6 weeks of life.
These lesions may appear on the skin or in the
internal organs
Most Hemangiomas are not painful
Basic Features
3.
All skin hemangiomas will be visible by six months
of age
May occur anywhere on the skin surface
They are most common on the scalp, face and neck
They may first show up as a small bruise, scratch or
tiny red bump
The lesions grow most often on the skin and less
frequently in the internal organs
Basic Features Skin
4.
Superficial hemangiomas, occur on the outer layers
of the skin, typically bright red to purple in color
Deep hemangiomas, grow under the skin in the fat,
may be blue, purple or even skin color if deep
enough under the skin
Mixed hemangiomas, the most common type of
hemangioma; have both superficial and deep
components
Types of Skin Lesions
5.
Most hemangiomas are round or oval in shape
larger lesions may follow the shape of the affected
body part
The size of hemangiomas varies; Some are very small
(1 mm), while others are very large (20 cm or larger)
Every hemangioma differs in how fast it grows and
how long it grows before it stops
Hemangiomas’ shape,
size and growth rate
6.
The growth phase: Newborn to 14 months (average 8
months); Hemangioma is growing rapidly (puffing
out), and the color is bright red
The resting phase: 8 to 14 months old, no change in
size, and the skin becomes less shiny
The Shrinking Phase:1 to 5 years, lesion shrinks, the
color changes to purple and gray, it may even fade
completely
Life Cycle
7.
The cause of infantile hemangioma is unknown although
Vascular endothelial growth factor (VEGF) regulation
anomalies may be at play
More common in girls than boys
Associated with Caucasians
More frequently in babies born very small or born several
weeks before their due date, the relationship to these
events is unknown
There is no specific geographical distribution
Increased risk in twin births but risk association is
unknown
Epidemiology
8.
Most lesions follow a predictable life cycle and
shrink without any additional treatment
About 25% of these lesions could develop
complication, requiring specialty care
Specialty care is offered through multidisciplinary
teams by vascular anomalies specialists
Factors affecting complications are the size, location
and speed of growth
Complications
9.
Interference with organ function: As a hemangioma
grows, it can interfere with organ function; often,
this interference relates to vision if a hemangioma
around the eye grows rapidly, may even lead to loss
vision; Monitor hemangioma on the eyelid
Ulceration: Skin over the hemangioma can break
down until the skin appears raw or shiny, it might
even develop a scab or crust, increases the risk of
infection and scarring, watch lesions in the diaper
and around the mouth, these heal slowly
Common Complications
10.
Bleeding: Skin over the hemangioma protects it from
bleeding easily, if a hemangioma is cut or injured, it
can bleed or develop a crust or scab, these blood
vessels are not normal and they tend to bleed rapidly
Scaring: final appearance of a hemangioma varies
from person to person and will depend on size,
location, and whether or not there was ulceration or
infection; Nose, lips, forehead, and ears are prone to
scaring
Common Complications
23.
Role of primary care physician is mostly supportive
Complicated cases are referred to vascular anomalies
specialists
Beta blocker (Propranolol) is highly effective
Steroids
Surgery
Vast majority of lesions do not need treatment
Treatment
24.
Ballah D, Cahill AM, Fontalvo L, et al. Vascular anomalies: what
they are, how to diagnose them, and how to treat them. Curr Probl
Diagn Radiol. 2011;40:233-247.
Bauland CG, Lüning TH, Smit JM, Zeebregts CJ, Spauwen PHM.
Untreated hemangiomas: growth pattern and residual lesions. Plast
Reconstr Surg. 2011;127:1643-1648.
Boye E, Yu Y, Paranya G, et al. Clonality and altered behavior of
endothelial cells from hemangiomas. J Clin. Invest. 2001;107:745-
752.
Chen TS, Eichenfield LF, Friedlander SF. Infantile hemangiomas:
an update on pathogenesis and therapy. Pediatrics. 2013;131:99-108.
Chiller KG, Passaro D, Frieden IJ. Hemangiomas of infancy.
Clinical characteristics, morphologic subtypes, and their
relationship to race, ethnicity, and sex. Arch Dermatol.
2002;138:1567-1576.
References
Editor's Notes
This is the most common form
Vascular crowding showing thin walled blood vessels. Some vessels show a communicating pattern but not shown well this slide. Crowded vessels small narrow morphology
Axial post contrast CT image shows diffuse enhancement of a large neck mass that replaces the deep and superficial portions of the right parotid gland in an infant.
Capillary Hemangioma = red "infants" Small packed capillaries that show up as red/pink
Cavernous.. blue "Children”, a cavernous hemangioma is made up of larger blood vessels that are dilated. The blood vessels are not as closely packed as in a capillary hemangioma, and the spaces (or "caverns") between them are filled with blood, first appear as a bluish swelling.
Parotid hemangioma is by far the most common tumor of the parotid gland in children. Here we see no airway obstruction but there is slight tracheal deviation without clinical significance.
exact mechanism of action of β-blockers for the treatment of IH is not yet completely understood, off the lable