Hemangioma of Skin - Types, Causes, Symptoms, and Diagnosis

Introduction:

Haemangioma is a tumor of blood vessels. It is a noncancerous or benign condition that can occur in any part of the body, such as skin, muscle, internal organs, or even bone. Hemangiomas are commonly found beneath or on the surface of the skin. They can develop on the face and neck region and vary in size, shape, and color. As hemangiomas are noncancerous, they do not require treatment. Still, if it is present on the skin in an aesthetically concerning area, the patient may seek medical help for cosmetic reasons. Hemangiomas rarely require invasive treatments such as surgeries unless the tumor is obstructive or located deep in muscle or bone or if it causes problems in breathing, vision, or eating.

What Are the Types of Hemangiomas?

The abnormal multiplication of blood vessels resulting in a lump or mass is called a hemangioma. It can be solitary or multiple in occurrence. There are different types of hemangiomas, such as:

• Capillary Hemangioma: Small capillaries that are normal in size can cluster together to form the most common type of hemangioma called a capillary hemangioma. The capillaries are held together by connective tissue. It is called superficial when it is present close to the surface of the skin and is bright red in color. It can be flat or raised or even may protrude out as a nodule. If it covers a large area, it is called angiomatosis or diffuse hemangioma.

• Compound Hemangioma: This type of hemangioma is a mix of cavernous and capillary types of hemangiomas.

• Cavernous Hemangiomas: Cavernous hemangiomas are made up of dilated blood vessels, unlike capillary hemangiomas, whose blood vessels are of normal size but closely packed. They are called deep and are bluish in color below the skin’s surface. The space between the blood vessels is filled with blood. They vary in size and location throughout the body.

• Lobular Capillary Hemangioma: These are also called pyogenic granulomas and appear as small red bumps on the face, arms, and hands. They can bleed easily with mild contact due to a large number of blood vessels. They are often associated with hormonal changes during pregnancy and are found on the gums in the mouth and nose and are called pregnancy tumors.

• Infantile Hemangioma: Hemangiomas that occur in infants at birth or within the first weeks or months after birth are called infantile hemangiomas. They are usually of capillary types, although cavernous and compound types also occur. It is found more in girls than in boys. Infantile hemangiomas form, grow rapidly, and eventually shrink. The time taken for this cycle varies, but the shrinkage should have finished by the time the child attains puberty. The shrinkage of the hemangioma is called involution or regression. Hemangiomas generally involute on their own without any intervention. It needs treatment only if the hemangiomas cause difficulty in vision, breathing, or eating. More than functional impairment, hemangiomas can cause self-confidence issues in the growing child if it is located on the neck, face, or scalp.

• Congenital Hemangiomas: Hemangiomas present at birth are called congenital hemangiomas. Those that are fully formed at birth and involute completely by the first year are called rapidly involuting congenital hemangiomas. Those that do not involute are called non-involuting congenital hemangiomas. Hemangiomas can occur in areas other than skin, such as bone, muscle, or other tissues. They are not as common as skin hemangiomas.

• Intramuscular Hemangiomas: Capillary hemangiomas are the most common in muscle. Intramuscular hemangiomas can occur at any age but most commonly in young adults, and can involve any muscle. They are rarely visible or show signs as they are located within the muscle. Rarely can they cause swelling in the area; the swelling increases with activity. As they can be painful muscular hemangiomas, they require treatment.

• Internal Organ Hemangioma: Hemangiomas can rarely occur in internal organs, frequently in the liver and intestine. Due to their location, they are diagnosed while testing for another purpose. They do not require treatment unless they cause symptoms.

• Bone Hemangiomas: Hemangiomas in the skull or spine in the population of age 50 to 70 years are the common type of bone hemangiomas. Both capillary and cavernous types can occur in bone. They can be located deep into the canal or on the surface of the bone. Like internal organ hemangioma, they do not cause any symptoms and are discovered during an MRI for another purpose.

What Are the Causes of Hemangioma?

The exact reason for the development of a hemangioma is not understood. Different hemangiomas have different causes. Injury, errors in the vascular system during fetal development, and pregnancy are some of the causes. For instance, infantile hemangioma occurs during fetal development. Pregnancy-related hemangiomas resolve post-partum. Some hemangiomas can also occur due to genetic abnormalities, such as in von Hippel-Lindau's disease.

What Are the Symptoms Associated with Hemangioma?

Hemangiomas are benign and rarely cause any symptoms. They vary from red to blue in appearance, mainly depending on the depth of the tumor. They can be seen on the skin, mouth, or lips and are soft when touched. They may be flat or slightly raised, but rarely do they appear as a continuation from a stalk. Superficial lesions can bleed if irritated or injured. Muscle hemangiomas can cause pain and swelling. Bone hemangiomas can cause the bone to enlarge and may cause pain.

How to Diagnose Hemangiomas?

Hemangiomas can be difficult to differentiate from other vascular malformations; hence a detailed physical examination and history taking are necessary for the diagnosis. This includes the determination of when the lesion started, the change in appearance, and whether it has involute or progressed. Additionally, the doctor may ask if there are any associated symptoms, such as pain or swelling.

• Palpation: The location, depth, and consistency of the lesion are determined by palpation.

• Imaging Modalities: In many cases, hemangiomas located in deep areas are found by chance during investigations for other disorders.

• Computed Tomography (CT) or X-rays: They are best suited for hemangiomas involving bones or dense structures. They are also used in determining cavernous hemangiomas and the presence of calcifications in hemangiomas called phleboliths.

• Magnetic Resonance Imaging (MRI): They are useful in determining soft lesions such as hemangiomas. Hemangiomas appear as worms in MRIs.

• Angiogram: This type of test is used to find abnormalities in blood vessels by injecting dye into the bloodstream. Hemangiomas are then detected on the imaging screen.

• Biopsy: Although hemangiomas are noncancerous, a biopsy is done to differentiate between hemangiomas and other tumors. This helps to determine the type of hemangioma.

• Blood Tests: The presence of multiple tumors can indicate a need for blood tests to determine if there are any underlying factors for the tumors.

Conclusion:

Hemangiomas are masses or tumors in blood vessels that are noncancerous in nature. They are usually asymptomatic and can be found in skin, bone, or muscles, skin being the most common location. It is sometimes associated with pain and swelling if it is found deep in the muscle or bone. They are of different types depending on the formation. It usually does not require medical intervention unless it affects any functioning or causes an aesthetic concern.