eMedicine Specialties > Plastic Surgery > Skin

Vascular, Hemangiomas: Follow-up

Author: Meir Cohen, MD, MPS, Consulting Staff, Department of Plastic Surgery, Schneider Children's Medical Center of Israel, Tel Aviv University
Coauthor(s): Eyal Raveh, MD, Consulting Staff, Department of Otolaryngology, Rabin Medical Center, Israel; Dan Ben-Amitai, MD, Head of Pediatric Dermatology Service, Lecturer, Schneider Children's Medical Center of Israel; Shimon Maimon, MD, Head of Invasive Radiology Unit, Beilinson Campus, Rabin Medical Center, Israel; Benjamin Shalev, MD, Consulting Staff, Ophthalmology Unit, Schneider Children's Medical Center of Israel; Moshe Lapidoth, MD, Head, Laser Service, Dermatology, Golda-Hasharon Hospital; Eric Bensimon, MD, Clinical Instructor, Department of Surgery, University of Montreal
Contributor Information and Disclosures

Updated: Mar 14, 2008

Outcome and Prognosis

Most hemangiomas appear during the first months of life, undergo proliferation with a peak at age 1 year, and then undergo gradual involution. Involution is 50% complete by age 5 years and 70% complete by age 7 years, with continued improvement up to age 10-12 years.5 An exception is congenital hemangioma, which is present at birth and usually undergoes regression at approximately age 1 year.5 Noninvoluting congenital hemangioma is a variant of the common hemangioma of infancy with persistent fast flow.24 Unlike vascular malformations, hemangiomas rarely cause bony distortion and overgrowth, with the exception of huge facial hemangiomas, which may affect the underlying bone and cartilage.5,25

Various associated medical conditions are discussed in Physical examination.

Future and Controversies

The introduction of a classification method by Mulliken and associates was a significant contribution to the understanding of vascular legions.1 This made diagnosis and treatment more accurate and predictable. However, confusing and occasionally wrong terms used by different subspecialties are still found.

Improvement in patient monitoring and anesthesia during and after surgery made early excisions safer and more acceptable. Other contributions included the introduction of the pulsed dye laser, which helps fade away the capillary component of hemangiomas,20 and the intralesional fiber laser.21,23

A major controversy is whether to wait until involution is complete or to operate early on children with disfiguring lesions. No clear-cut answer exists to this question. The authors believe that decisions should be made according to the individual situation. The psychosocial consequences of growing up with a facial deformity should always be taken into consideration.

Future genetic research, including angiogenic growth factor products, will contribute to the understanding of the mechanism underlying the formation of hemangiomas and may provide new modalities for treatment.7 Because bFGF and VEGF messenger RNA have been implicated in the pathobiology of human hemangioma formation, biochemical modulation of these angiogenic cytokines may eventually help inhibit proliferation and promote regression of hemangiomas.8

 


More on Vascular, Hemangiomas

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Multimedia: Vascular, Hemangiomas
References
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References

  1. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. Mar 1982;69(3):412-22. [Medline].

  2. Marler JJ, Mulliken JB. Current management of hemangiomas and vascular malformations. Clin Plastic Surg. 2005;32:99-116. [Medline].

  3. Patrice SJ, Wiss K, Mulliken JB. Pyogenic granuloma (lobular capillary hemangioma): a clinicopathologic study of 178 cases. Pediatr Dermatol. Dec 1991;8(4):267-76. [Medline].

  4. Boon LM, Enjolras O, Mulliken JB. Congenital hemangioma: evidence of accelerated involution. J Pediatr. Mar 1996;128(3):329-35. [Medline].

  5. Mulliken JB. Vascular anomalies. In: Aston SJ, Beasley RW, Thorne CHM, eds. Grabb and Smith Plastic Surgery. 5th ed. NY: Lippincott Raven Publishers; 1997.

  6. Hemangioma Investigator Group, Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, et al. Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr. Mar 2007;150(3):291-4. [Medline].

  7. Breugem CC, van Der Horst CM, Hennekam RC. Progress toward understanding vascular malformations. Plast Reconstr Surg. May 2001;107(6):1509-23. [Medline].

  8. Chang J, Most D, Bresnick S, Mehrara B, Steinbrech DS, Reinisch J, et al. Proliferative hemangiomas: analysis of cytokine gene expression and angiogenesis. Plast Reconstr Surg. Jan 1999;103(1):1-9; discussion 10. [Medline].

  9. Tan ST, Velickovic M, Ruger BM, Davis PF. Cellular and extracellular markers of hemangioma. Plast Reconstr Surg. Sep 2000;106(3):529-38. [Medline].

  10. Metry DW, Hawrot A, Altman C, Freiden IJ. Association of solitary, segmental hemangiomas of the skin with visceral hemangiomatosis. Arch Dermatol. May 2004;140(5):591-6. [Medline].

  11. Armstrong DC, ter Brugge K. Selected interventional procedures for pediatric head and neck vascular lesions. Neuroimaging Clin N Am. Feb 2000;10(1):271-92, x. [Medline].

  12. Takahashi K, Mulliken JB, Kozakewich HP, Rogers RA, Folkman J, Ezekowitz RA. Cellular markers that distinguish the phases of hemangioma during infancy and childhood. J Clin Invest. Jun 1994;93(6):2357-64. [Medline].

  13. Organek A, Cohen M, Zuker R. Interactive information kiosk improves patient knowledge and satisfaction in a busy pediatric plastic surgery clinic. Can J Plast Surg. 2000;8(3):105.

  14. Bonifazi E, Mileti F. Images in clinical medicine. Congenital hemangioma. N Engl J Med. Apr 8 1999;340(14):1080. [Medline].

  15. Sloan GM, Reinisch JF, Nichter LS, Saber WL, Lew K, Morwood DT. Intralesional corticosteroid therapy for infantile hemangiomas. Plast Reconstr Surg. Mar 1989;83(3):459-67. [Medline].

  16. Pope E, Krafchik BR, Macarthur C, Stempak D, Stephens D, Weinstein M, et al. Oral versus high-dose pulse corticosteroids for problematic infantile hemangiomas: a randomized, controlled trial. Pediatrics. Jun 2007;119(6):e1239-47. [Medline].

  17. Boon LM, MacDonald DM, Mulliken JB. Complications of systemic corticosteroid therapy for problematic hemangioma. Plast Reconstr Surg. Nov 1999;104(6):1616-23. [Medline].

  18. Ezekowitz RA, Mulliken JB, Folkman J. Interferon alfa-2a therapy for life-threatening hemangiomas of infancy. N Engl J Med. May 28 1992;326(22):1456-63. [Medline].

  19. Fawcett SL, Grant I, Hall PN, Kelsall AW, Nicholson JC. Vincristine as a treatment for a large haemangioma threatening vital functions. Br J Plast Surg. Mar 2004;57(2):168-71. [Medline].

  20. Scheepers JH, Quaba AA. Does the pulsed tunable dye laser have a role in the management of infantile hemangiomas? Observations based on 3 years' experience. Plast Reconstr Surg. Feb 1995;95(2):305-12. [Medline].

  21. Achauer BM, Celikoz B, VanderKam VM. Intralesional bare fiber laser treatment of hemangioma of infancy. Plast Reconstr Surg. Apr 1998;101(5):1212-7. [Medline].

  22. Achauer BM, Chang CJ, VanderKam VM, Boyko A. Intralesional photocoagulation of periorbital hemangiomas. Plast Reconstr Surg. Jan 1999;103(1):11-6; discussion 17-9. [Medline].

  23. Silfen R, Amir A, Regev D, Hauben DJ. Tumescence: a valuable adjunct for the excision of facial hemangiomas. Plast Reconstr Surg. Jul 2000;106(1):217-8. [Medline].

  24. Enjolras O, Mulliken JB, Boon LM, Wassef M, Kozakewich HP, Burrows PE. Noninvoluting congenital hemangioma: a rare cutaneous vascular anomaly. Plast Reconstr Surg. Jun 2001;107(7):1647-54. [Medline].

  25. Zuker MR, Cohen M. Congenital hand anomalies (discussion). In: Goldwyn RM, Cohen MN, eds. The Unfavorable Result in Plastic Surgery Avoidance and Treatment. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2000:710-13.

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Further Reading

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Keywords

Vascular hemangioma, hemangioma, vascular lesions, skin lesion, congenital skin lesion, congenital vascular lesion, acquired skin lesion, acquired vascular lesion, hemangiomas, capillary malformation, venous malformation, lymphatic malformation, slow-flow lesions, high-flow lesions, capillary hemangioma, strawberry hemangioma, cavernous hemangioma, superficial hemangioma, deep hemangioma, mixed hemangioma, mixed type hemangioma, malignant type hemangioma, spreading hemangioma, spreading lesion, involution phase, proliferation phase, PHACES syndrome, PHACES, pyogenic granuloma, facial deformity, facial disfigurement, spontaneous involution, facial hemangioma, periorbital hemangioma, forehead hemangioma, cheek hemangioma, nasal hemangioma, upper lip hemangioma, lower lip hemangioma

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Contributor Information and Disclosures

Author

Meir Cohen, MD, MPS, Consulting Staff, Department of Plastic Surgery, Schneider Children's Medical Center of Israel, Tel Aviv University
Meir Cohen, MD, MPS is a member of the following medical societies: American Cleft Palate/Craniofacial Association and Plastic Surgery Research Council
Disclosure: Nothing to disclose.

Coauthor(s)

Eyal Raveh, MD, Consulting Staff, Department of Otolaryngology, Rabin Medical Center, Israel
Disclosure: Nothing to disclose.

Dan Ben-Amitai, MD, Head of Pediatric Dermatology Service, Lecturer, Schneider Children's Medical Center of Israel
Dan Ben-Amitai, MD is a member of the following medical societies: Israel Medical Association
Disclosure: Nothing to disclose.

Shimon Maimon, MD, Head of Invasive Radiology Unit, Beilinson Campus, Rabin Medical Center, Israel
Disclosure: Nothing to disclose.

Benjamin Shalev, MD, Consulting Staff, Ophthalmology Unit, Schneider Children's Medical Center of Israel
Disclosure: Nothing to disclose.

Moshe Lapidoth, MD, Head, Laser Service, Dermatology, Golda-Hasharon Hospital
Disclosure: Nothing to disclose.

Eric Bensimon, MD, Clinical Instructor, Department of Surgery, University of Montreal
Eric Bensimon, MD is a member of the following medical societies: American Society of Plastic Surgeons, Canadian Society of Plastic Surgeons, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Shahin Javaheri, MD, Chief, Department of Plastic Surgery, Martinez Veterans Affairs Outpatient Clinic; Consulting Staff, Advanced Aesthetic Plastic & Reconstructive Surgery
Shahin Javaheri, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Wayne Stadelmann, MD, Stadelmann Plastic Surgery, PC
Wayne Stadelmann, MD is a member of the following medical societies: Alpha Omega Alpha, New Hampshire Medical Society, Northeastern Society of Plastic Surgeons, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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