Hemangioma

Alternative names
Cavernous hemangioma; Strawberry nevus

Definition
Hemangiomas are abnormally dense collections of dilated small blood vessels (capillaries) that may occur in the skin or internal organs.

Causes, incidence, and risk factors

The classically recognized hemangioma is a visible red skin lesion that may be superficial (in the top skin layers, called a capillary hemangioma), deeper in the skin (cavernous hemangioma), or a mixture of both.

Hemangiomas are usually present at birth, although they may appear within a few months after birth, often beginning at a site that has appeared slightly dusky or colored differently than the surrounding tissue.

Hemangiomas, both deep and superficial, undergo a rapid growth phase in which their volume and size increase rapidly. This phase is followed by a rest phase, in which the hemangioma changes very little, and an involutional phase where the hemangioma begins to disappear.

During the involutional phase, hemangiomas may disappear completely. Large cavernous hemangiomas distort the skin around them and will ultimately leave visible changes in the skin. Superficial capillary hemangioma may involute completely, leaving no evidence of its past presence.

Hemangiomas may be present anywhere on the body. However, they are most disturbing to parents when they are on the infant’s face or head. Hemangiomas of the eyelid may interfere with the development of normal vision and must be treated in the first few months of life. On rare occasions, the size and location of hemangiomas may interfere with breathing, feeding, or other vital functions. These lesions also require early treatment.

Large cavernous hemangiomas may develop secondary infections and ulcerate. Bleeding is common and may be significant following injury to the hemangioma.

Symptoms

     
  • A red to reddish-purple, raised lesion on the skin  
  • Can be a massive, raised tumor with blood vessels

Signs and tests

Hemangiomas are diagnosed by a physical examination. In the case of deep or mixed lesions, a CT scan or MRI scan may be performed to ensure that deeper structures are not involved.

Occasionally, a hemangioma may be associated with other rare syndromes. Additional studies may be done to determine if any of these syndromes are present.

Treatment

Superficial or “strawberry hemangiomas” often are not treated. Letting them disappear on their own produces normal-appearing skin. In some cases, a laser may be used to eradicate the small vessels.

Cavernous hemangiomas that involve the eyelid and obstruct vision are generally treated with injections of steroids or laser treatments that rapidly reduce the size of the lesions, allowing normal vision to develop. Large cavernous hemangiomas or mixed hemangiomas, when appropriate, are treated with oral steroids and injections of steroids directly into the hemangioma.

Recently, lasers have been used to reduce the bulk of the hemangiomas. Lasers emitting yellow light can selectively damage the vessels in the hemangioma without damaging the overlying skin. Some physicians are using a combination of steroid injection and laser therapy together.

Expectations (prognosis)
Small, superficial hemangiomas should disappear completely on their own. Large cavernous hemangiomas should be evaluated by a physician and treated appropriately.

Complications

     
  • bleeding  
  • visual abnormalities (amblyopia, strabismus)  
  • psychosocial problems

Calling your health care provider
All birthmarks, including hemangiomas, should be evaluated by the health care provider during a routine examination.

Prevention
There is no known way to prevent hemangiomas.

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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