1. HEMANGIOMAS
James Hansen

2. Definition of a Hemangioma
A benign skin lesion consisting of dense, usually elevated masses of dilated blood vessels.

3. Blood Vessel Formation
Blood vessels are tubes of endothelial cells surrounded by layers of smooth muscle cells and connective tissue proteins, which develop as a result of biochemical signals between the two.
Sometimes this communication fails and abnormal blood vessels form.

4. Probing Vascular Disorders
By analyzing gene mutations causing vascular abnormalities, much can be learned about the signals that are necessary to form normal blood vessel development.
Many studies are examining the causes of hemangiomas in children and the mechanisms underlying their growth.

5. Types of Hemangiomas Strawberry Hemangioma Cavernous (Deep) Hemangioma
Compound Hemangioma

6. Strawberry Hemangioma
strawberry red mark found on 1 out of 10 babies
small as a freckle or large as a coaster
consists of small closely packed blood vessels
95% disappear by the time the child is 10 years old

7. Cavernous (Deep) Hemangioma
deeply situated red-blue spongy mass of tissue filled with blood found on 2 out of 100 babies
grows rapidly in the first six months
composed of larger, more mature vascular elements
some of these lesions disappear on their own

8. Compound Hemangioma contains both superficial and deep parts
these are often the largest and the most spreading
similar characteristics to both the strawberry hemangioma and the cavernous hemangioma

9. Consider Treatment Treatment should be considered if the hemangioma….
ulcerates
bleeds
causes functional impairment
causes infection
grows rapidly and uncontrollably
causes psychological problems

10. Treatments of Hemangiomas
Medical
steroid injection
interferon alfa-2a
Surgical
resection
FPDL
YAG laser

11. Medical Treatments Steroid Injection
benefit in managing rapid growth or functionally disabling hemangiomas
prednisone or prednisolone administered with a dose of 2 to 4 mg per kg per day for two to three weeks
positive response to steroids is characterized by tactile softening, lightening color or slowed growth occurring within 7 to 10 days of initial dosage
if no response is seen then the treatment should be discontinued
side effects include cushingoid symptoms, growth retardation and infection

12. Medical Treatments Interferon Alfa-2a
benefit in inhibiting angiogenisis and stimulate endothelial cell prostacyclin formation, which prevents platelet trapping
interferon alfa-2a is administered in daily subcutaneous injections of 1 to 3 million units per square meter of body surface area for an average of 7 months of therapy
18 of 20 infants whose lesions were resistant to steroid therapy responded to interferon alfa-2a with a 50% regression rate
acute side effects, which are reversible, include fever, chills, arthralgias and retinal vasculopathy

13. Surgical Procedures Resection
surgical excision is occasionally advocated as the primary treatment of hemangiomas
resection surgically removes all or part of the tissue
indicated as the management of visceral lesions unresponsive to steroids
used for the cosmetic revision of redundant skin remaining after spontaneous involution of deeper hemangiomas

14. Surgical Procedures FPDL - flashlight-pumped pulsed dye laser
treatment of choice for superficial strawberry hemangiomas with a response rate of 60 percent
penetrates to a depth of 1.8mm and has a low risk of scarring
local anesthetic is effective in reducing pain or discomfort and some bruising may occur
several laser sessions may be needed to achieve optimal improvement

15. Surgical Procedures YAG Laser
treatment of choice for rapidly growing deep or mixed hemangiomas with a response rate of 75 percent
penetrates to a depth of 5 to 6 mm, although scar formation is more frequent than with the FPDL since the laser penetrates deeper into the skin
requires local or general anesthesia
not recommended in the initial treatment of cutaneous hemangiomas

16. Conclusion
hemangiomas may be unpredictable - they may proliferate, remain constant or involute
treat when vital anatomic areas are involved or growth is rapid
treat if bleeding, ulceration or infection occurs
make use of all modalities as needed

17. References
Eisenberg, Arlene & Hathaway, B.S.N., Sandee E. & Murkoff, Heidi E What To Expect The First Year.
New York: Workman Publishing Company
Lehrer, M.D., Michael. 10/28/2001. Birthmarks-Red.
April 11, 2003,
Lowitt, M.D., Mark H. & Wirth, M.D. Fern A. 2/15/1998. Diagnosis and Treatment of Cutaneous Vascular Lesions
April 11, 2003,
Olsen, M.D., Ph.D., Bjorn R The Forsyth Institute.
April 10, 2003,
American Osteopathic College of Dermatology Hemangiomas.
April 10, 2003,

18. Dedication
This presentation is dedicated to my daughter, Gabriella, who was diagnosed with a hemangioma located on her parietal lobe at birth.