Hemangioma

Hemangiomas are common, benign vascular birthmarks composed of a dense cluster of proliferating blood vessels. They can develop anywhere on the body, most often on the face, chest, or back, and typically appear as bright red to purple, either flat against the skin or raised as a soft, rubbery bump. While hemangiomas are best known as infantile birthmarks, adults can develop them too, most commonly as cherry hemangiomas. Most hemangiomas resolve on their own over time. Still, families and adult patients alike often turn to an experienced, board-certified dermatologist, such as Dr. Michele Green in NYC, for an accurate diagnosis and treatment guidance.

Although most hemangiomas require no medical intervention, some cases warrant closer monitoring or active treatment—including those that bleed, ulcerate, or develop near the eyes, mouth, or diaper area. Depending on the type and severity, treatment options may include beta blockers, corticosteroids, laser treatment, or, less commonly, surgical removal. Because an accurate diagnosis is essential to choosing the safest and most effective approach, Dr. Michele Green, a board-certified dermatologist in NYC, works closely with every patient to determine whether a hemangioma needs treatment and, if so, which option best suits their needs.

What is a hemangioma?

Hemangiomas are common, benign skin lesions composed of proliferating blood vessels. These growths can appear anywhere on the body — especially on the face, chest, and back — as red or purple lumps. They are usually harmless and often resolve on their own by age 10. Superficial hemangiomas, the most common type, consist of small blood vessels packed tightly together near the skin’s surface, which gives them their characteristic bright red color. Cavernous hemangiomas, by contrast, consist of larger blood vessels with fluid-filled spaces, or “caverns,” between them, and are usually deep and have a blue or purple tint.

Although hemangiomas are most common in infants and children, adults can develop them as well. While cherry hemangiomas typically don’t require medical treatment, several non-invasive options can reduce or remove a hemangioma and address any residual skin changes it may cause. Hemangiomas on the mouth or diaper area may require treatment because they are prone to bleeding, infection, and ulceration. Dr. Green, a board-certified dermatologist in NYC with a pediatric background, will work with you to select the treatment options best suited to resolving your child’s hemangioma.

What do hemangiomas look like?

Hemangiomas can occur anywhere on the body and are typically bright red to purple, appearing either flat and smooth against the skin or raised, even protruding as a nodule. Infantile hemangiomas usually go through a rapid growth phase during the first several months of life before beginning involution, the process in which the lesion shrinks and fades in color. While most infantile hemangiomas resolve completely by age 10, involution can occasionally leave residual skin changes, such as a wrinkled texture or lingering redness. Dr. Green’s private dermatology practice on Manhattan’s Upper East Side offers several non-invasive treatment options to reduce the appearance of a hemangioma or any residual skin changes it has caused.

How is a hemangioma diagnosed?

Typically, a skin hemangioma is diagnosed when a lesion first develops. A Doppler machine may be used to assess changes in blood flow around the affected area to confirm the hemangioma. In some cases, an ultrasound may be used to determine the hemangioma’s depth. Occasionally, an MRI or CT scan may be used for imaging, such as for a potential hemangioma of the liver or another internal organ.

Cherry angiomas vs Cherry hemangiomas

Cherry angiomas and cherry hemangiomas are common, benign vascular lesions that look similar but are composed of different cells. Cherry angiomas consist of blood or lymphatic vessels, whereas cherry hemangiomas are made exclusively of blood vessels. Cherry hemangiomas typically appear in infancy or childhood, whereas cherry angiomas usually develop in adulthood. The term “cherry” refers to the rich cherry-red to purple color of these growths, which are usually two to four millimeters in size and may be smooth and flat or raised and dome-shaped.

Cherry angiomas and cherry hemangiomas do not resolve on their own. While removal isn’t medically necessary, many patients choose treatment for cosmetic reasons. Dr. Michele Green offers several treatment options to remove cherry angiomas and hemangiomas with minimal discomfort, downtime, and scarring. Dr. Green works with each patient to create a personalized plan to achieve a clear, even-toned complexion that lasts.

Is a hemangioma dangerous?

Though this type of vascular tumor is typically harmless, painless, and low-risk, a hemangioma can be unsightly and, on occasion, interfere with an infant’s respiratory, auditory, digestive, or ocular systems. A hemangioma isn’t usually dangerous unless it obstructs vision or the airway or develops into an open wound; hemangiomas affecting the eye area may warrant an ophthalmology consultation. A hemangioma near the mouth or diaper area may be prone to bleeding, infection, or ulceration due to friction, in which case a board-certified healthcare provider with a pediatric background may recommend medical treatment. Dr. Green’s NYC dermatology practice can help with any concerns related to the diagnosis and treatment of hemangiomas.

Types of Hemangiomas

Hemangiomas are generally classified by their depth within the skin, growth pattern, and location on the body, and can include infantile, congenital, and later-onset hemangiomas.

Infantile Hemangiomas

An infantile hemangioma is a common vascular birthmark composed of extra blood vessels in the skin that typically appears at birth or within the first few weeks of life. Hemangiomas visible at birth are classified as congenital hemangiomas, a category that includes noninvoluting congenital hemangiomas (NICH) and rapidly involuting congenital hemangiomas (RICH). Infantile hemangiomas are usually painless and low-risk, but they can sometimes bleed or ulcerate, causing pain and discomfort. They are also occasionally linked to spinal or nervous system abnormalities and, if located on sensitive areas such as the face or neck, can be disfiguring. A large hemangioma on the face, scalp, or neck may indicate an increased risk of PHACE syndrome. This condition involves a series of vascular, endocrine, and neural abnormalities and malformations, and should be monitored by your healthcare provider.

Infantile hemangiomas are classified into one of the three categories below:

Superficial Hemangiomas (Strawberry marks or Capillary Hemangiomas)

This is the most common type of hemangioma, characterized by the classic bright red, rubbery bump or patch. It can have a textured surface and may appear as a distinct, raised bump or a milder, broader patch of skin. Strawberry marks are a type of superficial hemangioma, meaning they form close to the skin’s surface.

Deep hemangiomas (Cavernous Hemangiomas)

This type of hemangioma differs from the typical red bump and often appears darker, with a blue or purple tint. If a child’s hemangioma begins to swell, particularly between two and four months of age, it may be classified as a deep hemangioma.

Combination / Mixed hemangiomas

In a combined hemangioma, the vascular anomaly lies deep within the dermis, and a superficial stain appears on the skin’s surface. This classification is based on how much soft tissue the hemangioma involves.

Proliferative Hemangiomas

About 80% of children with a hemangioma present with a single vascular malformation, but proliferative hemangiomas — or multiple hemangiomas — remain common. Proliferative hemangiomas develop from proliferating endothelial cells, which line blood vessels. In general, patients with six or more hemangiomas may be at risk for problems involving the internal organs, particularly the liver. Infants tend to have only a small number of lesions. However, according to the Boston Children’s Hospital Vascular Anomalies Center, some infants can develop several hundred lesions under this classification.

Lobular Capillary Hemangiomas

This type of hemangioma appears as small red bumps on the hands, face, and arms. Each lesion contains a dense concentration of blood vessels, making the area prone to bleeding, even with minor contact. A lobular capillary hemangioma is sometimes called a “pregnancy tumor” because it commonly develops in the nose and mouth during pregnancy. These lesions are typically low-risk but can be delicate and should be monitored by your healthcare provider.

Internal Hemangiomas

In extremely rare cases, internal hemangiomas can develop in the internal organs. If a child presents with six or more infantile hemangiomas, it is common practice to examine the liver and spleen to detect any internal hemangiomas. An internal hemangioma typically won’t present with symptoms unless it grows large or is located in a sensitive area, in which case a patient may develop nausea or vomiting, loss of appetite, and abdominal pain or bloating. Doctors can confirm internal hemangiomas with computed tomography (CT) scans, magnetic resonance imaging (MRI), or ultrasound. The most common types of internal hemangiomas occur in the liver and the intestines.

Hemangioma Growth

Many hemangiomas go through growth phases. Infantile hemangiomas typically appear at birth or within the first few weeks of life and progress through several phases: an early rapid growth phase during the first few months of life; a slowing of growth around five months of age — when roughly 80% of hemangiomas stop growing; a plateau phase lasting several months during which the hemangioma remains unchanged; and finally involution, the process by which the hemangioma shrinks in size and fades in color. Many infantile hemangiomas resolve completely by the time a child is five years old, with most gone by the time a child is ten years of age. An involuted hemangioma can occasionally leave residual skin changes, such as a wrinkled texture or lingering redness; Dr. Green offers a variety of non-invasive treatment options at her private dermatology office in NYC to reduce their appearance without discomfort or downtime.

Hemangioma Treatment Options

Treatment for a hemangioma depends on several factors, including the size, location, and rate of growth or involution of the hemangioma, as well as any ulceration of the lesion(s) and the patient’s age. Hemangiomas often resolve without treatment, but removal or reduction may be recommended when one is located on the face, eyes, or along the spine. The following treatment options are available for a variety of hemangiomas:

• Laser therapy can be used to treat ulcerated hemangiomas and abnormal skin in the affected area. The Vbeam laser is the gold standard for removing vascular lesions, especially hemangiomas. Dr. Green is an expert in the Vbeam laser and has used it for over a decade in her private NYC dermatology office.
• Surgical removal is typically used for smaller hemangiomas that can be completely removed through minimally invasive surgery, often avoiding the need for general anesthesia.
• Topical beta-blockers, such as timolol, can be applied to small, superficial hemangiomas, as well as to ulcerative (open and bleeding) hemangiomas.
• Beta-blockers, such as oral propranolol, are a non-invasive hemangioma therapy. This can carry risks in infants, such as a slow heart rate and low blood pressure, and is often started under medical supervision.
• Corticosteroids are sometimes used if beta-blockers are ineffective. Young children may experience side effects, such as irritability or trouble sleeping.
• Embolization, in which the blood flow to the hemangioma is cut off, eventually eliminates the development of the vascular anomaly.

How to treat a hemangioma in adults

Although hemangiomas are most common in infants and children, adults can develop them too; about 75% of people aged 75 and older have cherry hemangiomas. While cherry hemangiomas usually don’t require medical treatment, many adults choose to have them removed for cosmetic reasons. Treatment options for adult hemangiomas are similar to those for children. Topical beta blockers may help lighten the hemangioma and slow its growth, working best on small, superficial hemangiomas. Topical antibiotics are prescribed for hemangiomas that have become ulcers or open sores that may become infected.

Oral medications such as propranolol and prednisone may be prescribed to reduce blood flow to the hemangiomas, thereby shrinking them. Surgical removal may be recommended if other treatments have failed. If the hemangioma has resolved except for residual redness, Dr. Green recommends the V-Beam laser treatment, which uses a wavelength that targets only red pigment, leaving surrounding skin cells untouched. Dr. Green also uses the V-Beam to treat rosacea, acne, post-inflammatory hyperpigmentation, stretch marks, post-surgical scars, and broken capillaries, among other skin conditions. When you consult with Dr. Green at her private dermatology office in NYC, she will work with you to determine which treatment options best suit your needs and goals.

Are hemangiomas genetic?

The exact cause of hemangioma formation is unknown, though it involves angiogenesis, the process by which new blood vessels form from pre-existing ones. Usually, hemangiomas develop by chance, although in some cases they may be inherited through autosomal dominant traits. Infantile hemangiomas are most common among premature babies with low birth weight or in twins and triplets, and typically appear at birth or within the first few weeks of life. Most infantile hemangiomas go through a rapid growth phase within the first few months of life, which ceases around five months of age, and then remain unchanged for several months before going through involution, during which the hemangioma shrinks in size and disappears, usually completely by the time a child is ten years of age.

Although hemangiomas are most common in infants and children, adults can develop them as well; in fact, about 75% of people aged 75 and older have cherry hemangiomas. While cherry hemangiomas usually don’t require medical treatment, many choose to have them removed for cosmetic reasons.

When does a hemangioma go away?

Hemangiomas usually go away by the time a child reaches ten years of age. About 80 percent of hemangiomas stop growing by about five months. Once the initial growth phase ends, the hemangioma remains unchanged for some time before involution begins, causing it to shrink and fade in color. Many hemangiomas resolve by age five. Sometimes, infantile hemangiomas that have undergone involution can cause residual skin changes, including wrinkled skin texture or a red appearance. Dr. Green can treat hemangiomas and resolve any residual skin changes, revealing a clear, even-toned complexion that lasts.

Frequently Asked Questions (FAQs) about Hemangiomas

What is a benign hemangioma?

A benign hemangioma is a noncancerous growth composed of a cluster of proliferating blood vessels. Unlike malignant tumors, a benign hemangioma does not invade surrounding tissue or spread to other parts of the body. Most resolve on their own without medical intervention. Although harmless, some patients choose treatment with Dr. Green to address the appearance of a hemangioma or the residual skin changes it may leave behind.

What causes a hemangioma?

The exact cause of hemangioma formation isn’t fully understood, but it involves angiogenesis—the process by which new blood vessels form from pre-existing ones. Hemangiomas typically arise from a proliferation of the endothelial cells that line blood vessels. While most develop by chance, some can be linked to inherited autosomal dominant traits. Vascular malformations, a related but distinct group of vascular birthmarks, differ from hemangiomas in that they are present at birth and grow proportionally with the child, rather than undergoing a rapid growth phase followed by involution.

What causes hemangioma in adults?

In adults, hemangiomas most often present as cherry hemangiomas, which become increasingly common with age — roughly 75% of people over age 75 develop them. Their exact cause remains unclear, but they are thought to result from age-related vascular changes rather than the growth-and-involution cycle seen in infantile hemangiomas. Hormonal shifts, including elevated estrogen from pregnancy, menopause, or hormone therapy, are also associated with the growth of certain hemangiomas, such as those affecting the liver.

Is a hemangioma a tumor?

Yes, a hemangioma is a type of tumor; however, not all tumors are cancerous. A tumor is a medical term for tissue growth that forms when abnormal cells clump together. Noncancerous tumors commonly affect the skin, bones, organs, glands, and tissues — they don’t spread to other parts of your body and aren’t life-threatening. Hemangiomas are common, noncancerous, benign tumors made of proliferating blood vessels that can often be removed without downtime or discomfort.

When to worry about a hemangioma?

Most hemangiomas are harmless and require only monitoring, but certain signs warrant prompt evaluation by a board-certified dermatologist. Patients should be concerned if a hemangioma is near the eyes, mouth, or diaper area; grows rapidly or becomes very large, especially on the face, scalp, or neck; bleeds, ulcerates, or shows signs of infection; or if six or more hemangiomas are present, which may indicate involvement of internal organs. Dr. Green can determine whether a hemangioma requires treatment or further evaluation.

What happens if a hemangioma bleeds?

Hemangiomas in areas prone to friction, such as the diaper area or the mouth, are more likely to bleed, ulcerate, or become infected. A healthcare provider should evaluate a bleeding hemangioma because ulceration can be painful and increases the risk of infection or scarring. Depending on severity, treatment may include topical or oral beta blockers, laser therapy, or wound care to promote healing and prevent complications.

Is an atypical hemangioma cancer?

An atypical-appearing hemangioma isn’t necessarily cancerous, but any lesion that changes in size, shape, or color, or that doesn’t match the classic presentation of a hemangioma, should be evaluated by a board-certified dermatologist, such as Dr. Green. In these cases, a biopsy may be performed to send tissue for laboratory analysis and to rule out skin cancer or another dermatologic condition. While hemangiomas are benign tumors, prompt evaluation of any atypical growth can provide peace of mind and help ensure an accurate diagnosis.

Can a cherry hemangioma be cancerous?

Cherry hemangiomas are usually benign, harmless, and not a major concern. These cutaneous vascular proliferations typically do not require treatment; however, if you develop new lesions or red spots, or notice a change in the appearance of a red mole, you should consult a dermatologist to determine whether the growth is a cherry hemangioma or another type of lesion or skin cancer. An expert dermatologist, such as Dr. Michele Green, can confirm whether the new growth or clinical changes in appearance warrant further evaluation and treatment. If needed, a biopsy may be performed and sent to a laboratory for histological review to rule out skin cancer or other dermatological conditions.

What doctor treats a hemangioma?

A board-certified dermatologist typically diagnoses and treats hemangiomas, ideally one with pediatric experience when the patient is an infant or child. Dr. Michele Green, a board-certified dermatologist in NYC, has extensive experience diagnosing and treating hemangiomas of all types — from infantile and congenital hemangiomas to cherry hemangiomas in adults — using a range of non-invasive and minimally invasive treatment options tailored to each patient.

What is a hepatic hemangioma? When should a liver hemangioma be removed?

Liver hemangiomas, also known as hepatic hemangiomas, occur when the endothelial cells surrounding the liver multiply. Liver hemangiomas can be infantile hemangiomas, but they sometimes occur unrelated to an infantile hemangioma; they are thought to grow more rapidly with increased estrogen, which can occur through hormone therapy during menopause, during pregnancy, or through the use of oral contraceptives. Liver hemangiomas may require surgical removal if there is a rupture, intratumoral bleeding, progressive abdominal pain in combination with a size greater than five centimeters, or compression of a nearby organ or vessel.

Is a spleen hemangioma dangerous? Is a brain hemangioma dangerous?

Splenic hemangiomas are very rare, benign tumors that are not treated unless they are very large or symptomatic; they are usually found incidentally, as most are asymptomatic. Brain hemangiomas, or hemangioblastomas, are also noncancerous and very uncommon. Hemangioblastomas are slow-growing and unlikely to recur after removal, though removal is usually recommended to prevent them from pressing against surrounding tissue.

What is a hemangioma on the spine? Are hemangiomas on the spine dangerous?

Spinal hemangiomas are the most common tumors of the spine and are usually found incidentally on imaging tests. These vascular lesions result from blood vessel proliferation and are usually benign and asymptomatic. Healthcare providers typically do not recommend removing spinal hemangiomas unless you have symptoms, such as pain or impaired movement.

What is a cavernous hemangioma?

A cavernous hemangioma consists of larger, dilated blood vessels. These hemangiomas can occur throughout the body, vary in size, and are usually described as ‘deep.’ Compared with capillary hemangiomas, the blood vessels in cavernous hemangiomas are not packed as closely — the spaces, or ‘caverns,’ between the vessels are filled with blood. Cavernous hemangiomas are less common than capillary hemangiomas. Capillary hemangiomas are the most common type of hemangioma, consisting of numerous blood vessels that are normal in diameter and tightly packed; they are also called superficial hemangiomas, and their proximity to the skin’s surface often makes them appear bright red. Superficial hemangiomas, like cavernous hemangiomas, can occur anywhere on the body, vary in size, and may be flat and smooth or raised, sometimes even protruding as a nodule.

Schedule Your Hemangioma Consultation with Dr. Michele Green Today

A hemangioma is a vascular birthmark composed of proliferating blood vessels that usually requires no medical treatment and resolves on its own over time. Most hemangiomas involute — shrinking in size and fading in color — by the time a child reaches ten years of age, though some may leave residual skin changes, such as a wrinkled texture or lingering redness. Consulting a board-certified healthcare provider with a pediatric background is the best way to confirm a diagnosis, monitor for complications, and explore treatment options for a hemangioma or its residual effects. Patients throughout NYC turn to Dr. Michele Green for her expertise in this area.

Dr. Michele Green is an internationally renowned, board-certified dermatologist in NYC with more than two and a half decades of experience, providing some of the world’s most discerning patients with the finest non-invasive cosmetic treatments, including hemangioma and cherry hemangioma removal. She takes a holistic approach and follows a less-is-more philosophy toward skin rejuvenation, customizing each patient’s treatment plan to address their specific skin concerns and aesthetic goals. Dr. Green is consistently recognized as one of NYC’s best dermatologists by Castle Connolly, New York Magazine, and Super Doctors for her dedication to her patients and clinical expertise. To learn more about treatment options for a hemangioma affecting you or a family member, contact us online or call Dr. Green’s NYC office at 212-535-3088 today.