Haemanagiomas

Understanding Hemangiomas in Children

Hemangiomas are benign vascular tumors that commonly affect infants and children, primarily appearing on the face. The good news is that many hemangiomas naturally regress over time, with no threat to life expectancy. For parents, the main concern is often the cosmetic aspect. They are non-cancerous so there is nothing to worry about the life expectancy of the children.

How Common Are Hemangiomas?

Hemangiomas are the most prevalent benign tumors in infants, with an incidence of 4% to 10% by the age of 1 year. Low birth weight and premature infants have a higher risk, up to 23%. These tumors typically don’t pose health issues but may rarely bleed or become painful.

Locations on the Body

Approximately 60% of hemangiomas occur on the head and neck, 25% on the trunk, and 15% on the extremities. Most hemangiomas present as a single tumor.

Classifying Hemangiomas

• Infantile Hemangiomas- More common, present in 70% of cases, develop after 2 to 8 weeks of birth, grow rapidly for 6 to 12 months, and slowly involute/ disappear eventually up to 10 years of age
• Congenital Hemangioma – Less common, present in 30% of cases, present at the time of birth, grows proportionately with the child’s growth, is either rapidly self-resolving or self-shrinking (within 12 to 18 months), or does not resolve at all.

Diagnosing Hemangiomas in Children

Diagnosis is usually made after a detailed history by the parents and physical examination of the child. Sometimes an Ultrasound, CT scan or MRI scan is done to see its extent and nature.

Is Treatment Necessary for Hemangiomas?

These tumors usually develop within the first few weeks of life but these usually resolve spontaneously by the age of 10 years. Depending on their size and location, they may be disfigured too.

Proper diagnosis by a trained plastic surgeon is a must.

Differentiation between other vascular tumors like Low flow vascular malformation and high-flow vascular malformation is a must before deciding on any treatment.

Key Points To Remember

• The size of the hemangioma and the sex of the child do not affect the speed and completeness of the resolution of the hemangioma.
• The location of hemangioma on the body has minimal effect on the final result after resolution.
• If a child has multiple hemangiomas, they usually do not necessarily resolve at the same time and with the same speed.
• The presence of ulceration has no prognostic significance except for scar appearance.

Treatment Options for Childhood Hemangiomas

• A single, small hemangioma usually requires no treatment. It’ll likely go away on its own. Total involution occurs in 50% of hemangiomas by 5 years, in 70% by 7 years, and in 90% by 9 years.
• However, some children may require treatment, such as skin hemangiomas that develop ulcerations or bleeding or are in specific areas on the face such as the lip, near the eyes. They can be treated with medications, laser, or surgery. Surgery is preferably avoided in babies and is done only if absolutely necessary.

Treatment Options for Hemangiomas at Kayakriti

1. Medicines

• a) Propranolol- is the first line of drug. It is used for its effect on the ACE enzyme expressed on immature capillaries of growing hemangioma. It induces apoptosis (self-eating of cells) and the development of fat in the hemangioma.
• b) Steroids- arrest growth of hemangioma but will not cause regression.
• c) Sclerotherapy- injection of the sclerosing agent into the Hemangioma will regress the growth and arrest further development.

2. Pulsed dye and Nd: YAG lasers can be used in the treatment of superficial hemangiomas, and a few ulcerated hemangiomas and for removing residual color from regressed hemangiomas. However, it is not a common modality of treatment.

3. Surgery: Hemangiomas within the body may require surgery only if they grow too large cause problems in vision or feeding or if it is bleeding. Surgery is typically delayed until the child is of school age and beginning to experience psychological consequences.

When Is Surgery Necessary?

1. Surgery is preferably avoided in children with hemangiomas as they can cause more severe deformities or scars after surgery.

2. Surgery is usually reserved for hemangiomas in children or babies if the medical treatment has failed and the tumor threatens important structures or functions like-

• a) Visual obstruction
• b) Ulceration/ bleeding
• c) Airway obstruction
• d) Ear canal obstruction

3. Surgery is more commonly done for regressed hemangiomas during adolescent and teenage years after the tumor has resolved and left a residual scar or deformity over the region.

Surgery For Regressed Hemangioma

Surgery of choice is the Excision of residual tumor or scar left by the hemangioma. The skin coverage is by multiple scar revisions or skin grafting with or without flap cover. For bigger scars, tissue expansion can be done.

The post-operative recovery is rapid and would require 3-4 days of hospitalization.