These are the most common benign tumors of infancy. They affect girls
five times more often than boys and occur in light skinned people more
often than those of darker complexion. They occur on the face or head
and neck area in over 80% of cases. Most are not present at birth and
become apparent within the first month of life. The current thought is
that hemangiomas develop from cells that cross from the placenta into
the baby and become lodged and grow.
Hemangiomas that are flat and involve the upper levels of the skin
are called superficial. Those that are deep in the skin and appear as a
lump are called deep. When a hemangioma has both a deep and a
superficial component it is called compound. The terms cavernous
hemangioma, strawberry hemangioma, stork-bite, angel kiss, and other
historical terms should all be dropped. They don’t describe the
birthmark in a way that is meaningful.
Once they appear they proliferate, or grow, for up to 18 months. Most
don’t grow past 6-8 months. Then they begin a slow process of
regression or involution. This period of involution is quite variable,
lasting over ten years in some patients. The degree to which the
birthmark involutes is also variable. Most doctors give the advice that
the birthmark will “go away” if you “leave it alone” for a long enough
period of time. This is what has been taught for decades and is no
longer held to be universally accurate. Yes, all hemangiomas regress to
some degree but the majority, however, do not involute to a cosmetically
acceptable level. In general, more than half of patients with a facial
vascular lesion who wait more than 5 years will end up having some
surgical or laser intervention because the result is not acceptable.
Our philosophy is, “If we can get a result now that is at least as
good as if we waited 5 years then why not do it now?” The time can be
used for touch up procedures, scar maturation, etc. A very important
element to take into account is the child’s developmental stage.
Children develop a sense of ‘self’ around 2 to 3 years of age. Around
that time they develop the ability to compare their bodies to others’.
They start to notice that mommy does not have the red thing on her nose
or that little brother’s cheek looks different. Of course, other 3 year
olds without birthmarks are learning the same. By age 5 most children
are getting close to starting school where the social pressures of
appearance and body differences become more acute. So, in keeping with
our early intervention philosophy, we try to get as much done as is
reasonable by age 3 and certainly by age 5 to try to avoid the
psycho-social effects.
In some cases, hemangiomas can be life threatening or functionally
impairing by interfering with vision, breathing, hearing or eating. Very
large hemangiomas can cause problems by trapping cells that aid in
blood clotting (Kassabach-Merritt phenomenon). Internal hemangiomas
involving the abdominal organs can be very problematic as well. When a
child has multiple external lesions and/or very large ones a search for
internal hemangiomas should be done. There is no exact number but, in
general, if there are more than 6-7 external ones consideration should
be given to looking for internal ones. Airway hemangiomas most typically
are found just below the vocal cords. They can be life-threatening and
present with noisy breathing. Aggressive treatment with steroids
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