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The Informed Parent

Hemangiomas: Blood Vessel Tissue

by Louis P. Theriot, M.D., F.A.A.P.
Published on Oct. 17, 1998

Samantha is a robust, healthy two week old who is in the office for her first visit. She has a shock of red hair that stands straight up, contrasted against her peaches and cream skin, creates a stark image. She is a perfect baby...except for a noticeable rose colored "V" in the middle of her forehead which comes to a point at the bridge of her nose. There is a similar patch of pink over her left eyelid. This bothers her mother who is re-assured that these are hemangiomas and that they present no problems to Sam, and they will go away with time.

Katie is a beautiful two week old who has a perfectly shaped head and facial features, pink skin, and a well-proportioned body. With the exception of a tiny pin point red dot on her cheek, she looks like a porcelain doll. Her mom is warned that this "dot" is a hemangioma, and that it will most likely grow bigger over the next few months. Little did she anticipate that by 9 months of age she would be in the office in tears because the hemangioma was the size of a nickel, occupying half of her cheek...a bright red lobulated mass that was most unsightly to mom. It was more difficult for Katie's mom to accept the same advice given to Sam's mom--leave it alone, and it WILL go away.

Both Sam and Katie have hemangiomas which are vascular, or blood vessel tissues, that are different from the surrounding "normal" vascular tissue. Hemangiomas are not cancerous or dangerous. The two most common type of hemangiomas are the salmon patch, and the strawberry hemangioma.

Samantha has a salmon patch which is very common, occurring in 40% of all newborn infants. These typically occupy the nape of the neck, the forehead, the eyelids or the area below the nose. Salmon patches represent "dilated" or stretched tiny blood vessels that are very near the skin's surface. They are not a growth or a mass. As a result, they are flat and can become more florid or noticeable when the baby cries or strains. The are not unsightly, and well over 95% of these hemangiomas will fade away completely by the time the baby reaches the age of two years. The so-called "stork bite" is a commonly seen salmon patch that is seen in the nape of the neck.

Katie, on the other hand, has a strawberry hemangioma. This is a benign neoplasm which is comprised of proliferating or overgrown blood vessels that have grown independently and unchecked by the surrounding normal vascular tissue. This type of hemangioma is present in 2-3% of all newborns, is much more common in females (3:1), and is more common in Caucasian babies. In tiny premature infants it's incidence is around 20%.

Strawberry hemangiomas are rarely present at birth, and only 30% are noticeable by a week of age. This is usually as a tiny red or purplish dot. The natural course of this type of hemangioma is for it to proliferate or grow rapidly during the first year of life at which time it reaches it's maximum size. There is no predicting how large they will become, and the sizes can vary from 1-2 millimeters, to 20 centimeters in size. No matter how large they become, over 90% will involute in time. This means that they outgrow their blood supply and disappear. About one third will disappear by the time the child is 3 years old, half are gone by 5 years, and around 90% are gone by age 10.

Strawberry hemangiomas can occur virtually anywhere on the body. They are only a problem if they grow in areas that interfere with vital bodily functions. If the hemangioma is in the eyelid, as it grows it may cover the pupil which would block the field of vision and lead to permanent visual problems. Hemangiomas in the nose or windpipe can be dangerous as they may interfere with normal breathing. Some hemangiomas in the lips or tongue may be quite large and can interfere with eating or speech. There have been hemangiomas that occur in vital organs such as the liver, and these can pose a risk. These all represent less than 5% of hemangiomas, but they do require some form of intervention to prevent complications. Treatment for these type of hemangiomas can include steroids, sclerosing agents, radiation, chemotherapy, or laser therapy. The type of treatment used would depend on a number of factors.

Five years later, Katie and Sam were both in the office for their kindergarten physicals. They had grown up to be healthy, cute little girls. Neither had even a trace of the hemangiomas that were present during their first year of life.

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