What Is Hemangioma?
Hemangioma refers to a benign tumor of vascular origin characterized by the abnormal growth of blood vessels in the skin or any internal organ. They are the most common benign tumor seen in infants. Hemangiomas in infants are referred to as “infantile hemangioma. It appears as a bright red vascular birthmark mostly seen during the first few weeks of life. After the first few weeks of life, hemangioma exhibits rapid growth for the next two to three months. Then there is a decline in its growth rate, and it gradually shrinks as the child gets older. Mostly by age 10, the traces of the lesion may completely disappear or only be faintly visible. They can occur anywhere in the skin, mucous membranes, or internal organs.
How to Differentiate Between Hemangioma and Vascular Malformations?
Hemangioma and vascular malformation are vascular lesions. Both vary from each other in their characteristics, outcomes and the way it is to be treated. However, hemangioma is often misinterpreted as vascular malformation. This states that not all vascular lesions are hemangiomas. Let us see some differences between both to have a better understanding:
What Are the Causes of Hemangioma?
The abnormal proliferation of blood vessels leads to the development of hemangioma; however, the exact cause of this abnormal proliferation is unknown. There is no food, medication, or other factors during pregnancy that causes a baby to develop hemangioma. Hemangioma is rarely hereditary.
What Are the Different Types of Hemangioma?
The different types of hemangioma include the following:
- Capillary Hemangioma: It is the most common type of hemangioma. In this condition, the capillaries are normal in size but high in number. Clinically it appears as a superficial raised lesion with bright red color. Capillary hemangioma affecting eyelids causes visual problems leading to a condition called“amblyopia( lazy eye).”
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Cavernous Hemangioma: In contrast to capillary hemangioma, cavernous hemangioma occurs due to dilation of large blood vessels. Blood vessels are not closely packed in this condition, and the spaces between them are filled with blood. They appear as a bluish swelling underneath the skin.
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Compound Hemangioma: It refers to the combination of capillary and cavernous hemangioma, which is seen in a few cases.
Types of Infantile Hemangioma:
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Superficial Infantile Hemangioma: Most common type of infantile hemangioma. It appears superficially on the skin's surface. Their characteristic appearance is a bright red color with a raised, uneven surface. Superficial hemangioma is often referred to as a “strawberry birthmark.”
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Deep Infantile Hemangioma: It appears as bluish-purple swelling underneath the skin with a smooth surface. Often diagnosed when the swelling becomes apparent, which takes place in two to four months.
In certain cases, hemangioma is seen deep inside the skin with a superficial stain. Such a condition is known as mixed hemangioma.
What Are the Symptoms of Hemangioma?
Hemangioma is usually painless, and the color of the lesion varies from red to blue depending on the skin surface affected. Superficial lesions tend to bleed or ulcerate more than deep lesions. Deep hemangioma involving muscle causes pain and swelling around the hemangioma. Hemangiomas involving bone induce severe bone pain and bone enlargement. Besides, skin hemangioma is also seen in;
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Liver (hepatic hemangioma).
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Lung (pulmonary hemangioma).
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Kidney (renal hemangioma).
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Colon.
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Brain.
What Is PHACE Syndrome?
PHACE syndrome refers to the collection of disorders characterized by large infantile hemangioma on the face, scalp, and neck, together with the combination of defects in the brain, blood vessels, eyes, chest, and heart. This condition is usually uncommon. The acronym PHACE refers to:
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P- Posterior fossa (a part of the brain) malformation.
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H- Hemangioma.
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A- Arterial lesions (abnormal arteries in the head or neck).
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C- Cardiac abnormalities or coarctation of the aorta (narrowing of the aorta from the heart).
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E- Eye problems or endocrine abnormalities.
PHACE is also sometimes denoted as PHACES syndrome, where “S” refers to abnormalities in the sternum (the breastbone). A child diagnosed with PHACE syndrome requires support and care from expert clinicians in several medical fields.
How to Diagnose Hemangioma?
Diagnosis of hemangioma should be made only by expert clinicians so that the condition cannot be misinterpreted as vascular malformation, which is entirely a different entity. The doctor usually carries out a clinical examination of the child's skin to differentiate between superficial and deep hemangioma. Deep hemangioma is difficult to diagnose; such conditions require detailed examination. Your doctor may advise taking an ultrasound and MRI to get a detailed view of the condition.
Hemangioma involving the head and neck requires MRI (magnetic resonance imaging). It gives a detailed view of the lesion involving blood vessels in the brain.
What Are the Treatment Options for Hemangioma?
The treatment options include both surgical and nonsurgical treatments. Doctors may suggest treatments based on the severity and type of hemangioma.
Nonsurgical Treatment: The nonsurgical treatments include:
- Beta-blockers:
- Oral Propranolol: It is highly effective in treating hemangioma by reducing growth and its size. It acts by blocking beta-adrenergic receptors that can make blood vessels narrower and reduces the amount of blood flowing through them. U.S. Food and Drug Administration ( FDA) approved the usage of Hemangeol (oral Propranolol hydrochloride) in 2014 for treating proliferating infantile hemangioma patients.
- Topical Beta-blockers: Timolol gel is used in treating small, superficial hemangioma.
- Corticosteroid Medication: To slow down the growth and size of infantile hemangioma, high-dose corticosteroids like Prednisolone are given.
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Laser Treatment: Laser treatments are helpful in tumor removal. Multiple laser treatments may be needed depending on the size, location, and extent of involvement of the tumor. It is highly useful in treating hemangioma involving the skin.
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Embolization: Embolization refers to the procedure that uses particles like gelatin sponges or beads to block a blood vessel. It helps in stopping bleeding or blocking the flow of blood to a tumor or an abnormal area of the tissue. It helps in reducing tumor size in hemangioma.
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Surgical Treatment: Surgical excision is the most preferred treatment for symptomatic deep subdermal or intramuscular hemangioma. The procedure involves the use of GA (general anesthesia) on the patient, followed by an incision and removal of the tumor. Complete excision of the tumor avoids recurrence of hemangioma.
Is Hemangioma Life-Threatening?
Yes, hemangioma could be life-threatening in certain cases. Large-size hemangioma involving vital organs which do not regress with time might be life-threatening. Severe conditions of hepatic hemangioma, pulmonary hemangioma (affecting the breathing system), and renal hemangioma become life-threatening and need proper medical care.
Are There Any Complications?
Although complications are rare, some of the common complications include:
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Ulceration or bleeding.
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The blurring of vision (if hemangioma involves the eye).
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Recurrence of the lesion (due to improper treatment of large hemangioma).
Conclusion:
Hemangioma is the most common benign tumor seen in infants. Since it affects mostly infants, an early diagnosis of the condition is much appreciable as it helps in better management of the disease. If any suspicious changes are noticed on the skin, it is always better to consult a doctor as soon as possible.
