Hemangioma

What is hemangioma?

A hemangioma is a type of benign (non-cancerous) tumor in infants. This abnormal cluster of small blood vessels appears on or under the skin, typically within one to three weeks after birth.

Often, there is no mark or only a faint birthmark on the skin that brightens in color and increases in size over the baby’s first 2-4 months of life (proliferative phase).

The area then stabilizes in size and color and then starts to fade and shrink (involution phase). Most hemangiomas are gone by 3 to 5 years of age. Some may cause residual areas of extra skin or small blood vessels called telangiectasias.

Most infantile hemangiomas cause no complications and go away without treatment. Between 4 to 10 percent of Caucasian infants are born with at least one hemangioma and they are three to five time more common in females (especially fair-skinned ones) than males.

Premature infants are more likely to have a hemangioma, and they occur more frequently in Caucasian infants than Asian infants, and are rare in African-Americans

Types of hemangiomas in children

Infantile hemangioma

There are three types of infantile hemangiomas, categorized by appearance and behavior:

Superficial hemangioma (“strawberry mark”)

  • most common type of hemangioma
  • raised bright-red patch, sometimes with a textured surface
  • can be focal (in one place) or diffuse (over a larger area)

Deep hemangioma

  • appear bruise-like or bluish in color
  • often diagnosed when swelling becomes apparent, usually around age 2 to 4 months

Combination

Lesions are deep under the skin with a cutaneous or superficial stain.

Multiple hemangiomas

Also called multifocal hemangiomas, these lesions appear on the skin, and if there are greater than five hemangiomas, they can have an increased risk for internal organ involvement. Multiple hemangiomas most commonly affect the liver. Children may have a few skin lesions to several hundred.

PHACE syndrome

Children with PHACE have a large hemangioma combined with other abnormalities.

Airway hemangiomas (subglottic or diffuse hemangioma)

A subglottic hemangioma is a large mass of blood vessels in the airway, typically below the vocal chords. They often grow for six to 12 months and then start to slowly shrink. It is a serious condition because the mass can obstruct the airway and affect a child’s ability to breath.

How we care for hemangiomas

At Boston Children’s Hospital we treat children with hemangiomas in our Vascular Anomalies Center, considered a premier center in the world for vascular anomalies. We offer:

  • Comprehensive team approach: At the Vascular Anomalies Center, patients and their families benefit from a comprehensive, team of specialists working together to develop a treatment plan customized for your child. Our clinic brings together the expertise of many fields including dermatology, hematology/oncology, interventional radiology (minimally invasive treatments), diagnostic radiology and surgery (plastic surgery and general pediatric surgery).
  • Unmatched expertise: Our team includes recognized experts in hemangioma care known for their ability to treat the full range of cases, from basic to multiple and more complex hemangiomas that may be associated with other conditions.
  • Expert, on-site diagnosis: Patients and their families look to our team for second opinions and diagnosis of severe hemangiomas. When needed, we can perform ultrasound testing within our clinic during your appointment to provide fast answers and more convenience.
  • Customized, leading treatments: We offer systemic medical management of hemangiomas using the latest and most advanced drug therapies available today. Many members of our team have been working with these medications since they were first prescribed for hemangiomas. Our team excels in customized or combined therapy plans to provide the most effective treatment possible.

Our areas of innovation for hemangiomas

At Boston Children’s Hospital, our vascular anomalies team is known for its expertise in diagnosing and treating the most severe and complex hemangiomas in infants and children.

Many members of our team have been working with propranolol and the latest medications used today since they were first studied in hemangioma patients. We continue to study the safety and effectiveness of the newest drugs and combination therapies, including:

  • propranolol
  • selective beta-blockers
  • topical beta-blockers, such as timolol
  • combination therapies using propranolol with steroids and topical agents such as timolol