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All hemangiomas
eventually stop growing, usually between 6 and 12 months of age.
After the proliferative phase ends, the hemangiomas slowly involute
over an average of 5 years. The blood vessels shrink, the size decreases,
and the color lightens. While all hemangiomas will exhibit regression,
and many will not require any treatment whatsoever, some can be
life threatening or vision threatening, and others can cause significant
scarring and distortion of facial features. Treatment ranges from
conservative observation to steroid therapy, laser therapy, surgical
intervention, and interferon therapy. Small hemangiomas are initially
managed most appropriately by pediatricians, but those of concern
are often referred to pediatric dermatologists and pediatric plastic
surgeons for further evaluation and management.
Vascular malformations
are much less common than hemangiomas, and are often incorrectly
diagnosed as hemangiomas. Microscopically they are composed of abnormally
formed capillaries, veins, lymphatics, and/or arteries that are
usually larger and weaker than normal vessels. Unlike hemangiomas
there is no proliferation phase. Vascular malformations appear to
grow because the vessels progressively dilate; they are not multiplying
and dividing. Conversely, there is no regression phase. Vascular
malformations do not go away, and it is important for parents to
understand that this is a lifelong condition.
| Types of vascular
malformations include: |
| Capillaries |
often called port wine stains |
| Veins |
venous malformations |
| Lymphatics |
lymphatic malformations (often still called
lymphangiomas and cystic hygromas) |
| Arteries |
arteriovenous malformations |
| Combinations |
Klippel-Trenaunay syndrome has abnormal
capillaries, veins, and lymphatics, often with overgrowth of
the involved region
Sturge-Weber syndrome may involve abnormal capillaries in the
upper face, with glaucoma, seizures, and possible brain involvement
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Treatment of vascular malformations
may include laser therapy, sclerotherapy, selective embolization,
surgical debulking, and compression garments.
The Hemangioma and Vascular
Malformation Clinic at the Children's Hospital of Philadelphia is
a multidisciplinary team comprised of plastic surgeons, interventional
radiologists, and dermatologists with a strong interest in evaluating
and treating these disorders. Additional specialists in oculoplastic
surgery, orthopedic surgery, otolaryngology, neurosurgery, and pediatric
general surgery may be involved in the care of patients whose hemangiomas
and vascular malformations require their expertise. Pediatric patients
are seen in the offices of the Division of Plastic Surgery, 1st
floor, Wood Ambulatory Care Building, 34th and Civic Center Boulevard,
Philadelphia, Pennsylvania 19104. Adults with vascular malformations
are seen at the offices of the Division of Plastic Surgery, Perelman
Center for Advanced Medicine, Philadelphia, PA
19104.
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The
most common are hemangiomas, which are composed of proliferating
(multiplying) tiny blood vessels known as capillaries. Hemangiomas
occur in up to 10% of infants, making them the most common
benign tumor of infancy. Girls are affected three times as
often as boys are. Most are not present at birth, but
appear during the first few weeks of life. Superficial hemangiomas
grow in the dermis layer of the skin and commonly begin as
small strawberry-colored dots that progressively enlarge.
Subcutaneous hemangiomas grow beneath the skin and appear
blue, and many hemangiomas have both a superficial and a deep
component. Many physicians still incorrectly call subcutaneous
hemangiomas "cavernous hemangiomas". They may think the blue
color is due to larger vessels, when it is actually their
deeper location that gives the capillaries a blue hue. Hemangiomas
may also grow internally, involving areas such as the parotid
gland, the eye region, the airway, and the liver. The majority
of hemangiomas occur in the head and neck area, but they can
grow anywhere. Infants can have more than one hemangioma,
and they often vary in size and grow at different rates.
