It is common to have all vascular anomalies called hemangiomas but they are not. You may hear these lesions referred to as capillary hemangiomas or strawberry birthmarks. There are actually two types of hemangiomas, infantile hemangiomas and congenital hemangiomas. They are similar in that they don’t tend to grow throughout life but there are some unique properties to each as well. Infantile hemangiomas are tumors containing small collections of abnormal blood capillaries which have been found to resemble placental tissue. They are vascular birthmarks that usually appears within the first few weeks of birth, some may even be seen as a small red mark or bruise at birth. They then grow intermittently, and sometimes quite rapidly, throughout the first 10 -12 months of life. After a year of age there is usually no more growth and the hemangioma starts its involutional phase. In this phase, the hemangioma can shrink, and lighten in color or it may not appear to do anything. Depending on how large the hemangioma has grown, this shrinking is frequently not enough to make the lesion “go away”. In fact a large percentage of hemangiomas will require some form of intervention to correct the deformity that has been caused by growth of the hemangioma or to correct scarring caused by ulceration. For this reason, there are several treatment options that are available to us to help control the growth as much as possible.
The second type of hemangioma is a congenital hemangioma. These are hemangiomas that are fully formed at birth. They usually don’t grow any more but they may or may not involute (shrink). There are two types of congenital hemangioma, the RICH or rapidly involuting congenital hemangioma and the NICH, non involuting congenital hemangioma. Like each of their names imply, one tends to go away rapidly and the other doesn’t really change at all.
Infantile hemangiomas can be classified by the areas they involve. Superficial hemangiomas involve skin only. Deep hemangiomas involve the layers of tissue below the skin and can vary in color from deep purple/blue to skin tones if they are really deep. Compound hemangiomas involve both the skin and deeper tissues.
There are many treatment options for hemangiomas and there are several things that we consider when we are deciding a correct management for a given patient. Observation is one form of treatment and is reserved for those hemangiomas that do not affect function, such as vision, or those that remain relatively small. Certain medicines can also be used to control the growth of hemangiomas including oral steroids, steroid injections and even some chemotherapeutic agents for more aggressive or life threatening situations. Lasers can be used to treat the superficial portions of the hemangiomas and finally sometimes surgery is required to correct disfigurement and restore normal function to the area affected by the hemangioma. Each hemangioma is different and a recommendation in each child’s case is dependent on consultation evaluation and not all treatment options are appropriate for every hemangioma. Our specialists, on the vascular anomalies team, offer all types of treatment for hemangiomas and the recommended treatment will fit the special case that each child presents.