HEMANGIOMAS

James Hansen

Definition of a Hemangioma

A benign skin lesion consisting of dense, usually elevated masses of dilated blood vessels.

Blood Vessel Formation

Blood vessels are tubes of endothelial cells surrounded by layers of smooth muscle cells and connective tissue proteins, which develop as a result of biochemical signals between the two.

Sometimes this communication fails and abnormal blood vessels form.

Probing Vascular Disorders

By analyzing gene mutations causing vascular abnormalities, much can be learned about the signals that are necessary to form normal blood vessel development.

Many studies are examining the causes of hemangiomas in children and the mechanisms underlying their growth.

Types of Hemangiomas

Strawberry Hemangioma Cavernous (Deep) Hemangioma Compound Hemangioma

Strawberry Hemangioma

strawberry red mark found on 1 out of 10 babies

small as a freckle or large as a coaster

consists of small closely packed blood vessels

95% disappear by the time the child is 10 years old

Cavernous (Deep) Hemangioma

deeply situated red-blue spongy mass of tissue filled with blood found on 2 out of 100 babies

grows rapidly in the first six months

composed of larger, more mature vascular elements

some of these lesions disappear on their own

Compound Hemangioma

contains both superficial and deep parts

these are often the largest and the most spreading

similar characteristics to both the strawberry hemangioma and the cavernous hemangioma

Consider Treatment

Treatment should be considered if the hemangioma….

ulcerates bleeds causes functional

impairment causes infection grows rapidly and

uncontrollably causes psychological

problems

Treatments of Hemangiomas

Medical

steroid injection

interferon alfa-2a

Surgical

resection

FPDL

YAG laser

Medical Treatments

Steroid Injection

benefit in managing rapid growth or functionally disabling hemangiomas

prednisone or prednisolone administered with a dose of 2 to 4 mg per kg per day for two to three weeks

positive response to steroids is characterized by tactile softening, lightening color or slowed growth occurring within 7 to 10 days of initial dosage

if no response is seen then the treatment should be discontinued side effects include cushingoid symptoms, growth retardation and

infection

Medical Treatments

Interferon Alfa-2a

benefit in inhibiting angiogenisis and stimulate endothelial cell prostacyclin formation, which prevents platelet trapping

interferon alfa-2a is administered in daily subcutaneous injections of 1 to 3 million units per square meter of body surface area for an average of 7 months of therapy

18 of 20 infants whose lesions were resistant to steroid therapy responded to interferon alfa-2a with a 50% regression rate

acute side effects, which are reversible, include fever, chills, arthralgias and retinal vasculopathy

Surgical Procedures

Resection

surgical excision is occasionally advocated as the primary treatment of hemangiomas

resection surgically removes all or part of the tissue indicated as the management of visceral lesions unresponsive

to steroids used for the cosmetic revision of redundant skin remaining after

spontaneous involution of deeper hemangiomas

Surgical Procedures

FPDL - flashlight-pumped pulsed dye laser

treatment of choice for superficial strawberry hemangiomas with a response rate of 60 percent

penetrates to a depth of 1.8mm and has a low risk of scarring local anesthetic is effective in reducing pain or discomfort and

some bruising may occur several laser sessions may be needed to achieve optimal

improvement

Surgical Procedures

YAG Laser

treatment of choice for rapidly growing deep or mixed hemangiomas with a response rate of 75 percent

penetrates to a depth of 5 to 6 mm, although scar formation is more frequent than with the FPDL since the laser penetrates deeper into the skin

requires local or general anesthesia not recommended in the initial treatment of cutaneous

hemangiomas

Conclusion

hemangiomas may be unpredictable - they may proliferate, remain constant or involute

treat when vital anatomic areas are involved or growth is rapid

treat if bleeding, ulceration or infection occurs make use of all modalities as needed

References Eisenberg, Arlene & Hathaway, B.S.N., Sandee E. & Murkoff, Heidi E.

1989. What To Expect The First Year. New York: Workman Publishing Company

Lehrer, M.D., Michael. 10/28/2001. Birthmarks-Red. April 11, 2003, http://www.pennhealth.com/ency/article/001440.html

Lowitt, M.D., Mark H. & Wirth, M.D. Fern A. 2/15/1998. Diagnosis and Treatment of Cutaneous Vascular Lesions April 11, 2003, http://www.aafp.org/afp/980215ap/wirth.html

Olsen, M.D., Ph.D., Bjorn R. 2000. The Forsyth Institute. April 10, 2003, http://www.forsyth.org/re/re_I_olsen.html

American Osteopathic College of Dermatology. 2001. Hemangiomas. April 10, 2003,

http://www.aocd.org/skin/dermatologic_disease/hemangiomas.html

Dedication This

presentation is dedicated to my daughter, Gabriella, who was diagnosed with a hemangioma located on her parietal lobe at birth.