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                                 D18.01 Hemangioma

A hemangioma (he-man-jee-O-muh) is a bright red birthmark that shows up at birth or in the first or second week of life. It looks like a rubbery bump and is made up of extra blood vessels in the skin.A hemangioma can occur anywhere on the body, but most commonly appears on the face, scalp, chest or back. Treatment for a baby's hemangioma (infantile hemangioma) usually isn't needed as it fades over time. A child who has this condition during infancy usually has little visible trace of the growth by age 10. You may want to consider treatment if a hemangioma interferes with seeing, breathing or other functions. 

Hemangiomas, or infantile hemangiomas, are noncancerous growths of blood vessels. They’re the most common growths or tumors in children. They usually grow for a period of time and then subside without treatment. They don’t cause problems in most infants. However, some hemangiomas may open and bleed or ulcerate. This may be painful. Depending on their size and location, they may be disfiguring. Additionally, they may occur with other central nervous system or spine abnormalities.

The growths may also occur with other internal hemangiomas. These affect internal organs such as:

• the liver
• other parts of the gastrointestinal system
• the brain
• organs of the respiratory system

Hemangiomas that affect organs usually don’t cause problems

Symptoms

A hemangioma may be present at birth, but more often appears during the first several months of life. It starts as a flat red mark anywhere on the body, most often on the face, scalp, chest or back. Usually a child has only one mark. Some children may have more than one, particularly if they're part of a multiple birth. During your child's first year, the red mark grows rapidly into a spongy, rubbery-looking bump that sticks out from the skin. The hemangioma then enters a rest phase and, eventually, it begins to slowly disappear. Many hemangiomas disappear by age 5, and most are gone by age 10. The skin may be slightly discolored or raised after the hemangioma goes away.

When to see a doctor

Your child's doctor will monitor the hemangioma during routine checkups. Contact your child's doctor if the hemangioma bleeds, forms a sore or looks infected. Seek medical care if the condition interferes with your child's vision, breathing, hearing or elimination.

Causes

A hemangioma is made up of extra blood vessels that group together into a dense clump. What causes the vessels to clump isn't known.

Risk factors

Hemangiomas occur more often in babies who are female, white and born prematurely.

Complications

Occasionally, a hemangioma can break down and develop a sore. This can lead to pain, bleeding, scarring or infection. Depending on where the hemangioma is situated, it may interfere with your child's vision, breathing, hearing or elimination, but this is rare. A healthcare provider can diagnose a hemangioma of the skin just by looking at it. No other testing is usually necessary.

Your healthcare provider may order blood tests or a skin biopsy if a growth appears to be abnormal or other sores are present. A skin biopsy involves removing a small piece of skin for testing. An MRI or CT scan is a way to examine a deeper hemangioma. These scans allow healthcare providers to visualize structures beneath the skin to see how deep the hemangiomas have grown and if they affect other structures in the body. Your healthcare provider may also use a Doppler ultrasound to see how blood flows through a hemangioma. A Doppler ultrasound may also help determine if the hemangioma is growing, resting, or shrinking.

Treatment

Superficial hemangiomas aren’t usually treated. As the child gets older, the growth tends to shrink and will usually disappear on its own.

If a hemangioma is in an area that could interfere with sight or breathing, treatment may be necessary. Treatment might also be necessary if the hemangioma is very large or breaks open and bleeds, causing discomfort.

Oral propranolol is the first-line treatment for hemangiomas needing systemic treatment.

If the hemangioma doesn’t adequately respond to propranolol or there’s a reason this medication can’t be used, corticosteroids, such as prednisone, can slow or stop the growth. They may be given:

• orally
• applied topically
• injected into the hemangioma

The potential side effects of steroids are serious and may include:

• poor growth
• high blood sugar
• high blood pressure
• cataracts

These side effects are given careful consideration before being prescribed. Severe side effects of propranolol may include:

• low blood pressure
• low blood sugar
• difficulty breathing

A medication called vincristine, which is used for other types of tumors, is also sometimes used to treat infantile hemangiomas that are unresponsive to other treatment methods

Treatments can shrink or remove the growth. Laser surgery can remove a large hemangioma of the skin that’s uncomfortable or is causing problems. Laser treatments can also reduce remaining discoloration after a hemangioma has healed. Your healthcare provider may also prescribe topical timolol maleate to treat thin or superficial hemangiomas.

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