Hemangioma

Dr. Michele Green treats patients of all ages in her NYC boutique office, and with a background in pediatrics, is uniquely suited to treating children and teens. If you or your newborn child has a bright red, rubbery bump on the skin, you may be looking at a hemangioma. A hemangioma is a type of vascular anomaly in which an abnormally large amount of small blood vessels group together to form a large clump on the skin. Hemangiomas are commonly classified as benign tumors,  and are typically present either at birth, or develop over the first few months of life. Caucasian, female, low-birthweight / premature infants are the most likely to present with a hemangioma. If you are concerned about a new rash or lesion on your child, it is best to consult with a board certified dermatologist, like Dr. Green, to examine your child in her private New York office.

What do hemangiomas look like?

Hemangiomas generally appear as a flat mark on the face, scalp, chest or back. Then, over the course of the first year of life, develops into a spongy bump on the skin. Typically, a hemangioma will slowly fade away or involute (turn inward), fully fading from the skin when a patient is between 5-10 years of age. A hemangioma can occasionally leave behind an altered texture or appearance on the affected skin after it fades.

Is a hemangioma dangerous?

Though this form vascular tumor is typically harmless, painless, and low-risk, hemangiomas can be unsightly and, on occasion, can get in the way of an infant’s respiratory, auditory, digestive, or ocular system. Dr. Green’s dermatology office is here to help for any concerns related to diagnosis and treatment of hemangiomas.

Types of Hemangioma

Infantile Hemangiomas

An infantile hemangioma is a common vascular birthmark that usually has no complications and goes away on its own. Infantile hemangiomas often develop shortly after birth; if one is visible at the time a child is born, it is referred to as a congenital hemangioma.

Infantile hemangiomas are typically painless and low-risk, but sometimes a hemangioma can bleed, causing pain and discomfort. Infantile hemangioma is also occasionally linked with spine or nervous system abnormalities and, if located on certain sensitive areas (such as the face or neck), can be disfiguring. If your child has a large hemangioma on the face, scalp or neck, they are at risk for PHACE Syndrome, which links a series of vascular, endocrine, and neural abnormalities and malformations. A large facial hemangioma should be regularly observed by your health care provider.

Infantile hemangiomas are categorized as one of the three classifications below:

Strawberry mark (Capillary Hemangioma):

This is the most common hemangioma classification, featuring the classic red, rubbery bump or patch. This mark can have a textured surface, and varies between a specific, acute bump, and a more mild, broader patch of the skin. It typically exists superficially (on the surface of the skin).

Deep hemangioma (Cavernous Hemangioma):

This hemangioma varies from the typical red bump, tending towards darker, bruise-like coloration. If your infant’s hemangioma begins to swell, particularly between 2-4 months of age, it may be classified as a deep hemangioma.

Combination / Mixed hemangioma:

In the case of a combination Hemangioma, the vascular anomaly is deep within the dermis, and a superficial stain will appear on the surface of the skin. This combination classification is defined based on the amount of soft tissue involved in the hemangioma.

If you think your child may have an infantile hemangioma, it’s best to monitor it with your healthcare provider. Dr. Green is available to examine any infantile hemangiomas and discuss treatment options for unsightly or disfiguring hemangiomas.

Proliferative Hemangiomas

About 80% of children with a hemangioma present with just one vascular malformation, but proliferative hemangiomas (or multiple hemangiomas) still remain common. Proliferative hemangiomas develop from a proliferation of the cells that line the blood vessel, known as endothelial cells.

In general, if a patient has six or more hemangiomas, they may be at risk for internal organ issues, particularly with the liver. Infants tend to have a small amount of lesions but, according to the Boston Children’s Hospital Vascular Anomalies Center, some infants can develop several hundred lesions with this type of hemangioma classification.

Lobular Capillary Hemangiomas

This type of hemangioma presents as small red bumps on the hands, face and arms. Each lesion has a concentrated amount of blood vessels which can make the area sensitive to bleeding, even with mild contact. A lobular capillary hemangioma can sometimes be referred to as a “pregnancy tumor” due to their common development in the nose and mouth during a pregnancy. They typically are low-risk, but can be delicate and should be monitored by your health care provider.

Internal Hemangiomas

In extremely rare cases, internal hemangiomas can develop on 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 in size or in a sensitive area. In this case, a patient may develop symptoms such as nausea/vomiting, loss of appetite, and pain/bloating in the abdomen. In internal hemangioma can be confirmed through a computed tomography (CT) scan, Magnetic Resonance Imaging (MRI), or ultrasound. The most common types of internal hemangiomas are of the liver and the intestines.

Liver hemangiomas, also known as hepatic hemangiomas. occur when the endothelial cells surrounding the liver multiply. Liver hemangiomas can be infantile hemangiomas, but sometimes occur unrelated to a hemangioma from infancy. They are thought to grow more rapidly with an increase in estrogen, which can occur through hormone therapy during menopause, during pregnancy, or through the use of oral contraceptives.

How is a hemangioma diagnosed?

Typically, a hemangioma can be diagnosed when a lesion first develops. A Doppler machine will sometimes be used to note any changes in blood flow surrounding the affected area, in order to confirm the hemangioma. In some cases, an ultrasound can be used as a tool to understand the depth of the hemangioma. Occasionally, an MRI or CT scan will be used, such as in the case of a potential hemangioma of the liver or another internal organ.

Can a hemangioma be removed?

In the case of an unsightly, disfiguring, or potentially hazardous hemangioma, a hemangioma can be removed through a variety of treatment options.

Treatment Options

Treatment for a hemangioma will depend on a variety of 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 age of the patient. Oftentimes, hemangiomas will go away without treatment, but when a hemangioma is located on the face, eyes, or along the spine, removal or reduction treatment options may be recommended.

The following treatments options are available to treat a variety of hemangiomas:

• Laser therapy, which can be used to treat ulcerated hemangiomas, as well as abnormal skin on the affected area of the hemangioma. The Vbeam laser treatment  is the gold standard for removing vascular lesions, especially hemangioma. Dr. Green is an expert in the Vbeam laser and has been using it for over a decade in her private NYC dermatology office.
• Surgical removal, typically used with smaller hemangiomas that can be completely removed through minimally invasive surgery.
• Topical beta-blockers, such as timolol, which can be applied to small, superficial hemangiomas, as well as to ulcerative (open and/or bleeding) hemangiomas.
• Oral beta-blockers, such as propranolol, which is a non-invasive hemangioma therapy.
• Corticosteroids, sometimes used in the event beta-blockers are ineffective. Side effects can occur in young children with this treatment, such as irritability or trouble sleeping
• Embolization, in which the blood flow to the hemangioma is cut off, eventually eliminating the development of the vascular anomaly.

If either you or a family member has a hemangioma, contact Dr. Green in her NYC office to learn about the best treatment options. You can also contact us online for further information and to help with your personalized treatment plan, or call 212-535-3088 today.