Subscribe to RSS
DOI: 10.1055/s-2008-1037451
Management of Cutaneous Juvenile Hemangiomas
Publication History
Publication Date:
20 February 2008 (online)
Abstract
Past descriptions of vascular lesions often confused vascular malformations and hemangiomas using interchangeable definitions which led to inappropriate treatment and inconsistency in the medical literature. The work of Mulliken and Glowacki systematically delineated the difference between hemangiomas and the multiple varieties of vascular malformations. Hemangiomas are in fact as the suffix “oma” suggests true tumors exhibiting cellular proliferation on histology. Additionally, treatment has been clouded by numerous reports in the literature of near universal complete spontaneous resolution and conversely arguments that every lesion demands treatment. More recently, thoughtful studies of the natural course of hemangiomas have been completed, algorithms for intervention versus observation proposed, and effective safe treatment plans devised. The following article will be presented in two sections. The first section will review the diagnosis and natural history of hemangiomas as appreciated in modern literature and compare this to a review of historical articles. This information will then be used to describe a rational and thoughtful algorithm for observation or intervention and recommend appropriate treatment options. Special emphasis will be given to surgical technique and several cases of late involuting hemangiomas of the face will be presented.
KEYWORDS
Hemangioma - classification - management algorithim - vascular birthmark - cutaneous
REFERENCES
- 1 Mulliken J B, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification bases on endothelial characteristics. Plast Reconstr Surg. 1982; 69 412-420
-
2 Waner M, Suen J Y.
A classification of congenital vascular lesions . In: Waner M, Suen JY Hemangiomas and Vascular Malformations of the Head and Neck. New York; Wiley-Liss 1999: 1-12 - 3 Jacobs A H. Strawberry hemangioma: the natural history of the untreated lesion. Calif Med. 1957; 86 8-10
- 4 Margileth A M, Museles M. Cutaneous hemangiomas in children. JAMA. 1965; 194 135-138
- 5 Lam S M, Williams E F. Vascular anomalies: review and current therapy. Curr Opin Otolaryngol Head Neck Surg. 2002; 10 309-315
- 6 Williams E F, Stanislaw P, Dupree M, Mourtzikos K, Mihm M, Shannon L. Hemangiomas in infants and children: an algorithm for intervention. Arch Facial Plast Surg. 2000; 2 103-111
- 7 Dinehart S M, Kincannon J, Geronemus R. Hemangiomas: evaluation and treatment. Dermatol Surg. 2001; 27 475-485
- 8 Bowers R E, Graham E A, Tomlinson K M. The natural history of the strawberry nevus. Arch Dermatol. 1960; 82 667-680
- 9 Lister W A. The natural history of strawberry naevi. Lancet. 1938; 1 1429-1434
- 10 Bivings L. Spontaneous regression of angiomas in children: twenty-two years' observation covering 236 cases. J Pediatr. 1954; 45 643-647
- 11 Lewis J R. The treatment of hemangiomas. Plast Reconstr Surg. 1957; 19 201-212
- 12 Kiehn C L, Desprez J D, Kaufman B. Cavernous hemangiomas of the head and neck: indications for arteriography and surgical treatment. Plast Reconstr Surg. 1964; 33 338-347
- 13 Matthews D N. Hemangiomata. Plast Reconstr Surg. 1968; 41 528-535
- 14 Matthews D N. Treatment of haemangiomata. Br J Plast Surg. 1953; 6 83-98
- 15 Li F P, Cassady R, Barnett E. Cancer mortality following irradiation in infancy for hemangioma. Radiology. 1974; 113 177-178
- 16 Moore A M. Pressure in the treatment of giant hemangioma with purpura: case report and observations. Plast Reconstr Surg. 1964; 34 606-611
- 17 Mangus D J. Continuous compression treatment of hemangiomata: evaluation in two cases. Plast Reconstr Surg. 1972; 49 490-493
- 18 Miller S H, Smith R L, Shochat S J. Compression treatment of hemangiomas. Plast Reconstr Surg. 1976; 58 573-579
- 19 Finn M C, Glowacki J, Mulliken J B. Congenital vascular lesions: clinical application of a new classification. J Pediatr Surg. 1983; 18 894-900
-
20 Waner M, Suen J Y.
The treatment of hemangiomas . In: Waner M, Suen JY Hemangiomas and Vascular Malformations of the Head and Neck. New York; Wiley-Liss 1999: 263-313 - 21 Dieterich-Miller C A, Cohen B A, Liggett J. Behavioral adjustment and self-concept of young children with hemangiomas. Pediatr Dermatol. 1992; 9 241-245
- 22 Williams E F, Hochman M, Rodgers B J, Brockbank D, Shannon L, Lam S M. A psychological profile of children with hemangiomas and their families. Arch Facial Plast Surg. , In press
- 23 Enjolras O, Riche M C, Merland J J, Escande J P. Management of alarming hemangiomas in infancy: a review of 25 cases. Pediatrics. 1990; 85 491-497
- 24 Bauman N M, Burke D K, Smith R JH. Treatment of massive or life-threatening hemangiomas with recombinant α-2a-interferon. Otolaryngol Head Neck Surg. 1997; 117 99-110
- 25 Barlow C F, Priebe C J, Mulliken J B et al.. Spastic diplegia as a complication of interferon alfa-2a treatment of hemangiomas of infancy. J Pediatr. 1998; 132 527-530
- 26 Achauer B M, Chang C J, Vander Kam V M. Management of hemangioma of infancy: review of 245 patients. Plast Reconstr Surg. 1997; 99 1301-1308
- 27 Burstein F D, Simms C, Cohen S R, Williams J K, Paschal M. Intralesional laser therapy of extensive hemangiomas in 100 consecutive pediatric patients. Ann Plast Surg. 2000; 44 188-194
- 28 Achauer B M, Vander Kam V M. Capillary hemangioma (strawberry mark) of infancy: comparison of argon and ND:YAG laser treatment. Plast Reconstr Surg. 1989; 84 60-69
- 29 Waner M, Suen J Y, Dinehart S. Treatment of hemangiomas of the head and neck. Laryngoscope. 1992; 102 1123-1132
- 30 Glassberg E, Lask G, Rabinowitz L G, Tunnessen W W. Capillary hemangiomas: case study of a novel laser treatment and a review of therapeutic options. J Dermatol Surg Oncol. 1989; 15 1214-1223
- 31 Haywood R M, Monk B E, Mahaffey P J. The treatment of early cutaneous capillary haemangiomata (strawberry naevi) with the tunable dye laser. Br J Plast Surg. 2000; 53 302-307
- 32 Lacour M, Syed S, Linward J, Harper J I. Role of the pulsed dye laser in the management of ulcerated capillary hemangiomas. Arch Dis Child. 1996; 74 161-163
- 33 Hohenleutner S, Badur-Ganter E, Landthaler M, Hohenleutner U. Long-term results in the treatment of childhood hemangioma with the flashlamp-pumped pulsed dye laser: an evaluation of 617 cases. Lasers Surg Med. 2001; 28 273-277
- 34 Garden J M, Bakus A D, Paller A S. Treatment of cutaneous hemangiomas by the flashlamp-pumped pulsed dye laser: prospective analysis. J Pediatr. 1992; 120 555-560
- 35 Enjolras O, Wassef M, Mazoyer E, Frieden I J, Rieu P N, Drouet L et al.. Infants with Kasabach-Merritt syndrome do not have “true” hemangiomas. J Pediatr. 1997; 130 631-640
- 36 Bennett M L, Fleischer A B, Chamlin S L, Frieden I J. Oral corticosteroid use is effective for cutaneous hemangiomas: an evidence-based evaluation. Arch Dermatol. 2001; 137 1208-1213
-
37 Waner M, Suen J Y.
Treatment options for the management of hemangiomas . In: Waner M, Suen JY Hemangiomas and Vascular Malformations of the Head and Neck. New York; Wiley-Liss 1999: 233-262 - 38 Sadan N, Wolach B. Treatment of hemangiomas of infants with high doses of prednisone. J Pediatr. 1996; 128 141-146
- 39 Haik B G, Karcioglu Z A, Gordon R A, Pechous B P. Capillary hemangioma (infantile periocular hemangioma). Surv Ophthalmol. 1994; 38 399-426
- 40 Plager D A, Snyder S K. Resolution of astigmatism after surgical resection of capillary hemangiomas in infants. Ophthalmology. 1997; 104 1102-1106
- 41 Warren S M, Longaker M T, Zide B M. The subunit approach to nasal tip hemangiomas. Plast Reconstr Surg. 2002; 109 25-30
- 42 Thomson H G. The cyrano nose: a clinical review of haemangiomas of the nasal tip. Plast Reconstr Surg. 1979; 63 155-160
- 43 Wallace H J. The conservative treatment of hemangiomatous nevi. Brit J Plast Surg. 1953; 6 78
- 44 Simpson J R. Natural history of cavernous hemangiomata. Lancet. 1959; 2 1057-1059
- 45 Mulliken J B, Rogers G F, Marler J J. Circular excision of hemangioma and purse-string closure: the smallest possible scar. Plast Reconstr Surg. 1979; 63 155-160
Edwin F WilliamsIII
M.D., F.A.C.S., Medical Director, Williams Center for Excellence
1072 Troy Schenectady Road, Latham, NY 12110