HEMANGIOMAS

James Hansen

Definition of a Hemangioma

A benign skin lesion consisting of

dense, usually elevated masses of
dilated blood vessels.

Blood Vessel Formation

Blood vessels are tubes of endothelial cells

surrounded by layers of smooth muscle cells
and connective tissue proteins, which develop
as a result of biochemical signals between
the two.
Sometimes this communication fails and
abnormal blood vessels form.

Probing Vascular Disorders

By analyzing gene mutations causing

vascular abnormalities, much can be learned
about the signals that are necessary to form
normal blood vessel development.
Many studies are examining the causes of
hemangiomas in children and the
mechanisms underlying their growth.

Types of Hemangiomas

Strawberry Hemangioma
Cavernous (Deep) Hemangioma
Compound Hemangioma

Strawberry Hemangioma

strawberry red mark found

on 1 out of 10 babies
small as a freckle or large as
a coaster
consists of small closely
packed blood vessels
95% disappear by the time
the child is 10 years old

Cavernous (Deep) Hemangioma

deeply situated red-blue

spongy mass of tissue filled
with blood found on 2 out of
100 babies
grows rapidly in the first six
months
composed of larger, more
mature vascular elements
some of these lesions
disappear on their own

Compound Hemangioma

contains both superficial and

deep parts
these are often the largest
and the most spreading
similar characteristics to both
the strawberry hemangioma
and the cavernous
hemangioma

Consider Treatment

Treatment should be
considered if the
hemangioma.

ulcerates
bleeds
causes functional
impairment
causes infection
grows rapidly and
uncontrollably
causes psychological
problems

Treatments of Hemangiomas

Medical

Surgical

steroid injection

resection

interferon alfa-2a

FPDL

YAG laser

Medical Treatments

Steroid Injection

benefit in managing rapid growth or functionally disabling

hemangiomas
prednisone or prednisolone administered with a dose of 2 to 4 mg per
kg per day for two to three weeks
positive response to steroids is characterized by tactile softening,
lightening color or slowed growth occurring within 7 to 10 days of initial
dosage
if no response is seen then the treatment should be discontinued
side effects include cushingoid symptoms, growth retardation and
infection

Medical Treatments

Interferon Alfa-2a

benefit in inhibiting angiogenisis and stimulate endothelial cell

prostacyclin formation, which prevents platelet trapping
interferon alfa-2a is administered in daily subcutaneous injections of
1 to 3 million units per square meter of body surface area for an
average of 7 months of therapy
18 of 20 infants whose lesions were resistant to steroid therapy
responded to interferon alfa-2a with a 50% regression rate
acute side effects, which are reversible, include fever, chills,
arthralgias and retinal vasculopathy

Surgical Procedures

Resection

surgical excision is occasionally advocated as the primary

treatment of hemangiomas
resection surgically removes all or part of the tissue
indicated as the management of visceral lesions unresponsive
to steroids
used for the cosmetic revision of redundant skin remaining after
spontaneous involution of deeper hemangiomas

Surgical Procedures

FPDL - flashlight-pumped pulsed dye laser

treatment of choice for superficial strawberry hemangiomas with

a response rate of 60 percent
penetrates to a depth of 1.8mm and has a low risk of scarring
local anesthetic is effective in reducing pain or discomfort and
some bruising may occur
several laser sessions may be needed to achieve optimal
improvement

Surgical Procedures

YAG Laser

treatment of choice for rapidly growing deep or mixed

hemangiomas with a response rate of 75 percent
penetrates to a depth of 5 to 6 mm, although scar formation is
more frequent than with the FPDL since the laser penetrates
deeper into the skin
requires local or general anesthesia
not recommended in the initial treatment of cutaneous
hemangiomas

Conclusion

hemangiomas may be unpredictable - they

may proliferate, remain constant or involute
treat when vital anatomic areas are involved
or growth is rapid
treat if bleeding, ulceration or infection occurs
make use of all modalities as needed

References

Eisenberg, Arlene & Hathaway, B.S.N., Sandee E. & Murkoff, Heidi E. 1989.
What To Expect The First Year.
New York: Workman Publishing Company

Lehrer, M.D., Michael. 10/28/2001. Birthmarks-Red.

April 11, 2003, http://www.pennhealth.com/ency/article/001440.html

Lowitt, M.D., Mark H. & Wirth, M.D. Fern A. 2/15/1998. Diagnosis and
Treatment of Cutaneous Vascular Lesions
April 11, 2003, http://www.aafp.org/afp/980215ap/wirth.html

Olsen, M.D., Ph.D., Bjorn R. 2000. The Forsyth Institute.

April 10, 2003, http://www.forsyth.org/re/re_I_olsen.html

American Osteopathic College of Dermatology. 2001. Hemangiomas.

April 10, 2003,
http://www.aocd.org/skin/dermatologic_disease/hemangiomas.html

Dedication

This
presentation is
dedicated to my
daughter,
Gabriella, who
was diagnosed
with a
hemangioma
located on her
parietal lobe at
birth.