Vascular Birthmarks and Hemangiomas

Hemangiomas | Malformations

Many babies are born with birthmarks. In 90% of these cases, the marks disappear by age one, however, about 10% of children have a significant vascular birthmark that requires the opinion of a specialist. Vascular birthmarks are made up of clustered blood vessels and can be raised or flat, pink, red, or bluish in appearance.

Vascular lesions are classified into 2 main groups:

  1. Vascular Tumors
  2. Vascular Malformations

In the majority of cases, it should be possible to decide which type of lesion your child has. A brief description of the types of vascular lesion will be given.

Vascular Tumors (including infantile hemangiomas)

Hemangiomas are by far the most common vascular tumors. The term hemangioma (infantile hemangioma) refers to a vascular lesion only evident in children. About 1 in 19 children will develop one. Hemangiomas are more common in Caucasians, twins, and females. Premature infants are also more likely to have a hemangioma.

Hemangiomas are usually not present at birth but develop within the first few days or weeks of life. Up to 30% may be present at birth as a flat reddish stain of the skin. The hallmark of hemangiomas is proliferation (growth) within the first few weeks after birth. This may be extremely rapid and quite alarming to the parents. The hemangioma will be quite firm, especially when the child cries.

There are 2 types of hemangiomas, focal and segmental (click here to see examples). Focal hemangiomas, as their name implies, are more localized and grow in a tumor-like fashion. These hemangiomas can grow for up to 6 to 9 months. Segmental hemangiomas are more diffuse and flat. As their name implies, their growth corresponds with the segmental development of the embryo. (click here to view the segments of the embryo). These hemangiomas can be very aggressive and locally destructive. They frequently ulcerate (lose their skin cover) and this is usually extremely painful. (click here to see an example of this). Ulceration may persist for months and can be difficult to heal. Segmental hemangiomas may be quite benign and present as a stain of the skin which will, over the ensuing years, disappear. Others can be aggressive and grow into plaque-like masses. Unlike their counterpart, the focal hemangioma, these hemangiomas can proliferate for up to 24 months. During this period, they may be quite destructive, distorting local tissue contours and ulcerating sometimes with significant tissue loss.

Eventually all hemangiomas stop growing and begin to involute (shrink). Each hemangioma will do this at its own pace. Some involute rapidly (over 2 to three years whereas others may take up to 12 years to involute. It is important to understand that the end point of involution can be quite variable. Some will involute and leave barely a trace, whereas others will hardly shrink at all. By about 2 to 3 years of age, it should be possible to determine whether or not your child’s hemangioma is shrinking rapidly or not. Rapidly involuting hemangiomas usually leave little trace of their presence at the end of this process. On the other hand, slow involuters are more likely to leave a significant residuum. This may take many forms, all of which require treatment.