Hemangioma

Benign vascular tumors characterized by abnormal proliferation of blood vessels

Epidemiology

• Most common benign tumor of infancy and early childhood

• Incidence: 4–10% of infants

• Female predominance (≈3:1)

• More common in:
• Premature infants
• Low birth weight infants
• Caucasian infants

• Usually absent at birth or appear within first weeks of life

Aetiology

• Local tissue hypoxia

• Angiogenic factors (VEGF, bFGF)

• Placental embolization theory

Pathophysiology

• Clonal proliferation of endothelial cells

• Overexpression of angiogenic factors

• Characteristic expression of GLUT-1 (distinguishes infantile hemangioma from other vascular malformations)

Clinical presentation

Natural History (Hallmark)

1. Proliferative Phase
• Birth to 6–9 months (up to 12 months)
• Rapid growth in size and thickness

2. Plateau Phase
• Stabilization of growth

3. Involution Phase
• Begins around 1 year
• Gradual regression over several years
• Color changes from red → gray → pale
• Residual skin changes may persist (atrophy, telangiectasia, fibrofatty tissue)

Common Locations

• Head and neck (≈60%)

• Trunk

• Extremities

• Perineal area (higher ulceration risk)

Investigations

• Primarily clinical

• Ultrasound with Doppler: confirms vascular nature

• MRI: deep, segmental, or complicated lesions

• Biopsy: rarely needed

Management

Observation (Most cases)

• Small, uncomplicated lesions

• Parental reassurance and monitoring

Indications for Treatment

• Risk of functional impairment

• Ulceration

• Rapid growth

• Cosmetic disfigurement

• Life-threatening complications

First-line Therapy

Alternative / Adjunctive Therapies

• Systemic corticosteroids (second-line)

• Laser therapy (ulceration or residual telangiectasia)

• Surgery (residual deformity)