Hemangiomas
By Lisa Glickstein, Ph.D, Triplet Mom
Originally printed in August 2004

When is a birthmark of concern to parents?  "What is that strawberry mark on my child's
face or body and why is it growing?"  "Our child has been diagnosed with a hemangioma 
and we've been told to just wait and it will go away by itself - but I'm worried - 
what should we do?"

Hemangiomas are a common benign (not cancerous) tumor of blood vessels.  They are more 
common in girls and in premature infants.  They occur in three forms that differ in 
appearance.  "Superficial" hemangiomas are the typical strawberry birthmarks of 
children, and occur in the skin surface.  "Deep" hemangiomas are beneath the skin, 
and have a bluish appearance.  "Compound" hemangiomas extend both into and beneath 
the skin.  Most hemangiomas occur on the face, which is one reason that they are of 
concern.  About one in five occurs elsewhere on the body.  Some deep hemangiomas can 
occur in a location that interferes with proper body function (e.g. breathing, sight).  
Very rarely, a deep internal hemangioma occurs in the liver or other internal organ 
and is life-threatening.  The risk is highest for children with more than three 
visible hemangiomas, and such children should be evaluated by ultrasound.

About a third of hemangiomas are present at birth, and the remainder appears during 
the first year of life.  Hemangiomas have three stages - precursor changes to the 
area, rapid growth of the lesion over the course of up to a year, and slow resolution 
(also called involution).  All hemangiomas involute - however this process can take 
3-9 years and the eventual result may not be cosmetically acceptable.  Patients 
with a small superficial hemangioma on the trunk, or small deep hemangioma, may not 
require treatment.  However, patients in whom the hemangioma is life threatening, 
causing physical dysfunction, or is disfiguring, should be referred for treatment 
to a vascular or plastic surgeon who specializes in related conditions.

Treatment is either topical steroid cream (for small superficial lesions only), oral 
medication (steroids or interferon), surgery (especially for deep lesions), or 
laser treatment. Most treatment is successful. There are a number of active doctors 
in Massachusetts. To find a doctor near you, contact your pediatrician or the 
Vascular Birthmarks Foundation (www.birthmark.org) for more information.