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Hemangioma - Causes, Symptoms, Diagnosis, and Treatment

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Hemangioma is a benign (noncancerous) tumor of blood vessel origin. This condition most commonly affects infants. Read this article to know more about it.

Written by

Dr. Ramji. R. K

Medically reviewed by

Dr. Kaushal Bhavsar

Published At November 18, 2022
Reviewed AtAugust 2, 2023

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:

differentiate-between-hemangioma-and-vascular-malformations

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).”
  • 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.

  • Compound Hemangioma: It refers to the combination of capillary and cavernous hemangioma, which is seen in a few cases.

Types of Infantile Hemangioma:

  • 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.”

  • 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;

  • Liver (hepatic hemangioma).

  • Lung (pulmonary hemangioma).

  • Kidney (renal hemangioma).

  • Colon.

  • 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:

  • P- Posterior fossa (a part of the brain) malformation.

  • H- Hemangioma.

  • A- Arterial lesions (abnormal arteries in the head or neck).

  • C- Cardiac abnormalities or coarctation of the aorta (narrowing of the aorta from the heart).

  • 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:
  1. 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.
  2. Topical Beta-blockers: Timolol gel is used in treating small, superficial hemangioma.
  3. Corticosteroid Medication: To slow down the growth and size of infantile hemangioma, high-dose corticosteroids like Prednisolone are given.
  • 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.

  • 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.

  • 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:

  • Ulceration or bleeding.

  • The blurring of vision (if hemangioma involves the eye).

  • 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.

Frequently Asked Questions

1.

How Serious Is Hemangioma?

Most hemangiomas are self resolvable. However, in some cases, they may require medical intervention if they cause functional or cosmetic issues and interfere with vital organs. Consulting a doctor and properly evaluating the size and location of hemangioma help to treat it appropriately.

2.

Is Hemangioma Cancerous?

Most hemangiomas are a proliferation of blood vessels. They are non-cancerous and are usually benign. Hemangiomas very rarely become cancerous and do not require any medication. Some hemangiomas can be disfiguring, and people may seek cosmetic reasons. However, most cases may not require surgery.

3.

Should Hemangiomas Be Removed?

Most hemangiomas disappear with time, so they may not require removal. Removal of hemangioma is recommended in the following cases.
- Interference with vision or breathing.
- Leading to skin ulcerations.
- Causes significant discomfort or pain. 

4.

Which Is the Best Treatment for Hemangioma?

The treatment of hemangioma depends on the size, location, and severity of the condition. Some of the commonly used treatments include
- Corticosteroids shrink the hemangioma and reduce inflammation.
- Beta-blockers slow the progression of hemangioma.
- Surgery may be recommended in severe cases.

5.

Are Hemangiomas Caused Due to Birth Defects?

More commonly, hemangiomas are observed in babies born prematurely and with low birth weight. Children may have more than one hemangioma. Some individuals may have hemangiomas due to hereditary causes. However, hemangiomas are not usually considered birth defects.

6.

Is Biopsy Needed for Hemangioma?

Usually, a biopsy is not required to diagnose a hemangioma. A dermatologist usually diagnoses hemangioma based on appearance. However, in some cases, a biopsy could be helpful to confirm the diagnosis or rule out the other conditions that present with hemangioma. 

7.

Does Hemangioma Disappear?

Yes, most hemangiomas will involute or shrink with time and may eventually disappear by the time the child reaches school age. However, in some cases, the hemangioma may leave behind residual discoloration or textural changes. In such cases, the treatment involves topical or oral medication and may sometimes involve cosmetic procedures.

8.

Are There Any Risk Factors Involved in Hemangioma?

Several risk factors may increase the risk of developing hemangioma, which are mentioned below.
- Infants born before 37 weeks may have increased risk.
- Girls are more prone to develop hemangiomas when compared to boys.
- A family history of hemangioma may increase the risk of developing one.

9.

Can Hemangioma Be Genetic?

Various researches suggest that genetic factors play a vital role in the development of hemangioma. Some studies have found that hemangioma can run in families, and there may be a genetic component to the condition. However, specific gene involvement may contribute to the development of hemangiomas.

10.

Does Hemangioma Grow in Size?

Hemangiomas can grow in size due to abnormal proliferation of blood vessels. After reaching a peak size, most hemangiomas shrink and disappear. However, some hemangiomas may persist to grow and may require topical or oral medications to treat the condition and prevent complications.

11.

What Are the Types of Hemangiomas?

Hemangiomas are of various types, which are mentioned below
- Superficial Hemangioma - It is also known as strawberry hemangioma and is raised and has a bright red color. This is because they are present close to the skin surface.
- Deep Hemangioma - They are located deeper into the skin and are usually blue or purple in color. They are less common when compared to superficial hemangioma.

12.

Does a Hemangioma Burst?

Hemangiomas may not usually burst. It is a benign tumor with abnormal proliferation of blood vessels. It is not prone to bleeding or bursting. However, rare cases may ulcerate and develop a break in the skin. This can lead to bleeding and other complications. Prompt treatment is recommended to prevent infection.

13.

Can Hemangiomas Be Removed by Dermatologists?

- Dermatologists can remove hemangiomas. If the hemangioma causes symptoms or affects the skin's appearance, the dermatologist may perform the below treatment options.
- Corticosteroid creams or ointments to apply on the skin to reduce inflammation.
- Systemic medications like Propranolol are prescribed to shrink the hemangioma.
- Surgical removal may be advised if the hemangioma affects the vital organs.
Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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