Hemangiomas are benign tumors composed of endothelial cells and are common in infancy. They have a natural history of rapid growth during the first few months of life, followed by a slow involutive phase until partial or complete regression of the lesion.
What is the cause for a Hemangioma to form ?
Its pathogenesis has yet to be fully clarified; however, studies suggest a dysregulation in vascular homeostasis due to an error in development occurring in the first trimester of pregnancy.
Do all hemangiomas regress ?
Complete regression occurs at a rate of 10% per year, 50% of hemangiomas regressing within a five-year period. Hemangiomas that do not involute by the sixth year of life will develop residual abnormalities, the most common of which are telangiectasias (superficial blood vessel network seen on skin), atrophic wrinkling, yellowish discoloration, redundant skin, scarring and alopecia (loss of hair).
What are the treatment modalities for hemangiomas ?
The goals in the management of hemangiomas are to prevent or reverse the complication of alarming hemangiomas, to prevent permanent disfigurement, minimize psychosocial stress for patients and relatives, avoid aggressive and potentially unsightly procedures and prevent or adequately treat ulceration, thereby minimizing scarring, infections and pain.
Systemic corticosteroids constitute the most common form of therapy in severe cases. Their principal effect is to halt growth and, if possible, induce regression of the lesion, possibly by inhibiting new blood vessel formation. Prednisone and prednisolone are the most commonly used oral drugs. Intralesional corticosteroid therapy is used in cases of hemangiomas around the eye or in smaller lesions; however it has more severe side effects. Interferon is indicated for the treatment of alarming hemangiomas when the tumor fails to respond to treatment with oral corticoids. Antineoplastic agents have been used in rare cases in which the hemangioma fails to respond to treatment with corticosteroids or interferon. Sclerotherapy is indicated for some deep hemangiomas. Some of the sclerosing agents used include ethanol and others. New forms of therapy have been tested, among them a topical immunomodulator, which was evaluated with good results in superficial hemangiomas in the proliferative phase. Radiotherapy has been practically abandoned because of long term sequelae. Compression therapy is another therapeutic option; however, disadvantages include possible ulceration and the discomfort provoked by pressure.
What are the surgical treatment modalities for hemangiomas ?
Early surgical intervention is used in cases in which the condition has the potential to affect patients’ self-esteem such as hemangiomas at the tip of the nose, eyelids or prominent hemangiomas that fail to respond to clinical treatment. The surgical technique traditionally used is circular excision.
Cryosurgery is more effective when performed in older children and in small lesions. The most common complications are atrophy, scarring and changes in pigmentation.
Different types of laser may be used in the management of hemangiomas, including argon, CO2,Nd:YAG and, more recently, long-pulsed tunable dye laser (LPTDL).
Embolization is seldom used due to the risk of particle migration. In complicated vascular tumors this technique may be used prior to surgical resection.
Vascular ligation may be considered with caution in cases of arteriovenous fistulae and when there is intense bleeding.
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
