Birthmarks come in all shapes and sizes. A hemangioma---- once known specifically as a strawberry hemangioma---- is a birthmark that appears as a bright red patch or a nodule of extra blood vessels in skin. It grows during the first year of life and then recedes over time. A hemangioma is usually benign and isn’t associated with other medical conditions.
· A hemangioma, which is sometimes referred to as infantile hemangioma, may be present at birth or appear during the first several weeks of life. It starts out as a flat red mark anywhere on the body, most often the face, scalp or back of the neck.
· During first year of life, the red mark becomes a spongy mass that protrudes from the skin----often growing rapidly up to 2 or 3 inches (about 5 to 7.5 centimeters) in diameter. The hemangioma then stops growing and enters a rest phase. Eventually, it begins to slowly disappear.
· Half of all hemangiomas resolve by age 5, and nearly all hemangiomas are resolved by age 10. Although the color of the birthmark also fades, faint---- but permanent---- discoloration of the skin or residual extra skin may remain.
o 30% resolve by the child’s 3rd birthday; 50% resolve by the 5th birthday and 70% of hemangiomas resolve by the 7th birthday
· A hemangioma consists of an abnormally dense group of extra blood vessels. It’s not clear what causes the blood vessels to group together, although some research suggests a link between hemangiomas and certain proteins produced by the placenta during pregnancy.
· Ulceration is the most common complication. It may lead to pain, infection, bleeding scarring, may interfere with sleeping/feeding habits
o Early white discoloration can be a clue that the lesion is going to ulcerate
· Hemangiomas in general may block vision, affect feeding/breathing/ hearing. (recall- most have a benign course)
· Locations with unique risks
o Periorbital area
§ May cause refractive errors, astigmatism, strabismus, ptosis, stimulus deprivation ambloyopia. Permanent visual deficits
o Pelvic/Perineal areas
§ May be associated with urogenital/anorectal anomalies (hypospadias, imperforate anus, atrophy or absence of labia minora)
§ Likely to ulcerate and become infected due to friction and chemical trauma
§ May be associated with spinal anomalies (occult spinal dysraphism, tethered spinal cord, lipomeningomyelocele)
§ US and MRI are warranted in infants with hemangiomas overlying the midline of the lumbosacral region
§ Most common location for hemangiomas of infancy (head/neck)-60% of cases
o Lip/oropharynx/nasal tip/ears
§ May incompletely involute
§ May require surgical intervention to minimize scarring and deformity
§ May involve the parotid gland
§ Do not usually compromise the facial nerve
o Diffuse facial
§ Tends to be in a segmental distribution (frontonasal, maxillary or mandibular)
§ More likely to ulcerate
§ Increased likelihood of visceral hemangiomas (liver, GI tract, brain)
o PHACES syndrome
§ Large facial segmental hemangiomas in association with visceral hemangiomastosis meet criteria
· Posterior fossa brain malformation, multiple Hemangiomas, Arterial anomalies such as coarctation of the aorta, Cardiac defects, Eye abnormalities
o Beard distribution (preauricular, chin, lower lip, anterior neck)
§ Associated with laryngeal or subglottic hemangiomas that may RAPIDLY compromise airway
o Laryngeal and subglottic
§ May cause stridor, persistent cough, hoarseness, respiratory distress, cyanosis
§ Many will present with respiratory symptoms between 6-12 weeks of life
§ NEEDS xrays, MRI, or laryngoscopic visualization to determine extent of involvement