Superficial infantile hemangioma
To access the content, please log in to the platform.
Image
Licensed by Depositphotos Inc.
- Localization. Trunk and extremities
- Erythematous lesion? Non-erythematous lesion
- Evolution time. Chronic: more than 2 weeks
- Skin lesion. Flat: macule or spot, Raised: papule, plaque or nodule
- Surface texture. Normal/smooth
- Edges Well defined and regular
- Color. Due to blood: pink, red, purple or purple
- Distribution of lesions. Discreet/isolated injury: 1 to 5 injuries
- Associated symptoms.
- Additional information.
Brief information
- Benign vascular tumor most common in childhood, with an incidence varying between 2-12% in the first year of life.
- More common in females (3:1). Prevalence increases in premature babies and Caucasians.
- Risk factors include twin pregnancy, advanced maternal age, placenta previa, and preeclampsia.
- It is usually absent at birth, becoming clinically evident by 1-4 weeks. However, precursor lesions such as:
- pale area of vasoconstriction; erythematous macule; red telangiectatic macule or bruise-like blue spots.
- They can be superficial, deep or mixed:Superficial lesions normally affect the superficial dermis and are elevated and may have a nodular or plaque-like appearance, bright red in color, elastic in consistency, and are poorly compressible.
- deep lesions involve the deep dermis and appear as partially compressible nodules or tumors, with a bluish hue, prominent venous network or superficial telangiectasias.
- Mixed lesions have a superficial component (bright red tone) and a deep component (deeper bluish tone).
- They can occur focally (most common, 67%) or, less commonly, affect an anatomical unit/body segment (segmental hemangioma).
- Segmental hemangiomas have a greater correlation with structural anomalies, complications and the need for treatment.
- The evolution of hemangioma comprises 3 phases:
- growth phase (proliferative): becomes evident at 2-3 weeks and shows continuous growth until 9-12 months.
- stabilization phase (quiescent/plateau): remains stable for a period of months (6-12 months)
- involution phase: marked by a change in color (turns to a darker red, with grayish areas). They become softer and more compressible. It is estimated that the involution of the lesion occurs at a rate of 10% per year (90% of lesions regress completely or partially by the age of 9). They may leave residual changes at the site (e.g. telengiectasia, sagging skin).
Differential diagnosis
- Vascular malformations (present at birth)
- Flat angiomas (“Salmon Patch”)
- Port wine stains (“Naevus flammeus”)
- Arteriovenous malformations
- Venous malformations
- Rapidly involuting congenital hemangioma
- Pyogenic granuloma (rare in newborns)
- Kaposi’s sarcoma
- Angiosarcomas
Treatment
- The majority of infantile hemangiomas have a favorable evolution, with spontaneous regression, and an expectant attitude is recommended with periodic evaluation documented by photography.
- Referral for additional treatment or evaluation presents:
- Potentially fatal complications: bilateral cervicofacial or mandibular hemangiomas (“bearded” distribution, with risk of airway obstruction [!] warning of stridor and progressive dysphonia [!]), large or multifocal hepatic (risk of heart failure or hypothyroidism), cerebral or spinal cord (risk of compression or hemorrhage).
- Functional risk: orbital or eyelid hemangioma (risk of amblyopia, strabismus), ear canal (hearing loss, compression), labial (feeding difficulties), nasal (airway obstruction) and perineal (risk of ulceration).
- Suspected PHACES syndrome (posterior fossa malformations/hemangiomas/arterial anomalies/cardiac defects/eye
abnormalities / sternal cleft / supraumbilical raphe syndrome): if there is a large or segmental hemangioma of the face. - Suspected PELVIS syndrome (perineal hemangioma/external genitalia malformations/lipomyelomeningocele/vesicorenal
abnormalities / imperforate anus / skin tag): there is a large or segmental hemangioma of the lumbosacral region. - Pain and/or ulceration
- Aesthetic risk (elective treatment to reduce the possibility of long-term aesthetic compromise)
- Consider psychosocial disturbance for the parents and, in the future, for the patient himself, particularly if the hemangioma is facial.