Hemangioma

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Hemangioma
Classifications and external resources
A capillary haemangioma
ICD-10 D18.0
ICD-9 228.0
ICD-O: M9120/0
DiseasesDB 30033
MedlinePlus 001459
eMedicine orthoped/499 
MeSH D006391
Histopathology of cutaneous capillary hemangioma. Skin biopsy. Hematoxylin and eosin stain.
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Histopathology of cutaneous capillary hemangioma. Skin biopsy. Hematoxylin and eosin stain.

A Hemangioma is a benign tumour of blood vessels that in most cases will disappear by itself over time. They are formed either during gestation or appear during the first few weeks of life and may present as a birthmark. Hemangiomas occur in approximately ten percent of Caucasians, and are less prevalent in other races. Females are three to five times more likely to have hemangiomas than males. Hemangiomas can be vivid superficial lesions (often referred to as "Strawberry Marks), if they are under the skin they appear as a bluish swelling. Sometimes they can be both superficial and deep. Approximately eighty percent are located on the face and neck, with the next most prevalent location being the liver. Although hemangiomas are benign, some serious complications can occur.

Hemangiomas are relatively common in newborns, and tend to disappear without treatment. The appearance of the tumor may be mistaken for a sign of physical abuse.

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[edit] Complications

The vast majority of hemangiomas are not associated with complications. Hemangiomas may break down on the surface to form ulcers. If the ulceration is deep, significant bleeding may rarely occur. Ulceration on the diaper area can be painful and problematic.

If a hemangioma develops in the larynx, breathing can be compromised. If they form on an eyelid or in the eye socket, blindness may result. Very rarely, extremely large hemangiomas can cause high output heart failure due to the amount of blood that must be pumped to the excess blood vessels. Lesions adjacent to bone can also cause erosion. Another possible complication hemangiomas can cause involves the nervous system. If a hemangioma attaches itself to a nerve bed, they can cause partial or whole paralysis of the region that they are situated. The most frequent complaints about hemangiomas, however, stem from psychosocial complications: the condition can affect a person's appearance and can provoke attention and malicious reactions from others. Particular problems occur if the lip or nose is involved, as distortion can be difficult to treat surgically.

[edit] Treatment

Most hemangiomas disappear without treatment, leaving none to minimal visible marks. Large hemangiomas can leave visible skin changes secondary to severe stretching of the skin or damage to surface texture. When hemangiomas interfere with vision, breathing or threaten significant cosmetic injury, they are usually treated. The mainstay of treatment is oral corticosteroid therapy. If this fails, surgical removal often becomes necessary. Blockage of the airway will often require a tracheostomy to be performed (insertion of an external airway through the front of the neck into the trachea below the level of the obstruction). Smaller raised lesions are sometimes treated with injection of corticosteroid directly into the lesion. Pulsed dye laser can be useful for very early flat lesions if they appear in cosmetically significant areas or for those lesions that leave residual surface blood vessels in the case of incomplete resolution.

Ulceration will usually heal with topical medication and special dressings under medical supervision. Sometimes pulsed dye laser can be used to accelerate healing.

[edit] Prognosis

Hemangiomas go through three stages of development and decay. First is the proliferation stage, where the hemangioma grows very quickly. This can last up to twelve months. Second is the rest stage, where there is very little change in the hemangioma's appearance. This usually lasts until the infant is one to two years old. Third is the involution phase, where the hemangioma finally begins to diminish in size. Fifty percent of lesions will have disappeared by age five with most of the rest gone by ten years of age.

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