Superficial hemangiomas are flat and involve upper levels of skin.
Compound hemangiomas are deep in the skin and appear as a lump.
The terms cavernous hemangioma, strawberry hemangioma, stork-bite, angel kiss, and other historical terms should all be dropped. They don’t describe the birthmark in a way that is meaningful.
Once the hemangioma appears it grows for up to 18 months. Often they will not grow past 6-8 months and then they begin a slow process of regression or involution. The process of involution is variable and can last for over 10 years in some patients.
Many patients and physicians have been taught that if they leave the birthmark alone it will “go away.” This is no longer held to be universally accurate. All hemangiomas will regress in some degree but most will not involute to a cosmetically acceptable level.
However, hemangioma growth can be quite variable, and while all start off small, some can grow quite large. If left untreated, hemangiomas of the face and neck are of greatest concern, because they can alter the surrounding soft tissues and structures in ways that will not go away on their own.
That is one reason it’s important for hemangiomas to be diagnosed and treated while infants are very young.
Today the American Academy of Pediatrics recommends that all four-week-old infants with a visible birthmark be referred to a vascular birthmark specialist, so action can be taken quickly if needed.
In general, more than half of patients with a facial vascular lesion who wait more than 5 years will end up having some surgical or laser intervention because the result is not acceptable.
Our philosophy is, “If we can get a result now that is at least as good as if we waited 5 years then why not do it now?” The time can be used for touch up procedures, scar maturation, etc.
A very important element to take into account is the child’s developmental stage. Children develop a sense of ‘self’ around 2 to 3 years of age. Around that time they develop the ability to compare their bodies to others’.
Children will begin to notice that they look different from their parents and siblings. When they start school they already are learning social pressures of appearance and the differences in their bodies become more acute. Our early intervention philosophy involves working to correct the birthmark as much as is reasonable by the age of 3 and certainly by age 5 to prevent the psycho-social effects of hemangiomas.
In some cases, hemangiomas can be life threatening or functionally impairing by interfering with vision, breathing, hearing or eating. Very large hemangiomas can trap cells that aid in blood clotting (Kassabach-Merritt phenomenon). Internal hemangiomas involving the abdominal organs can be very problematic as well.
A search for internal hemangiomas should be done when a child has multiple external lesions or very large lesions. A general rule of thumb is if there are more than 6-7 external hemangiomas there should be a search for internal lesions.
Airway hemangiomas are most typically found just below the vocal cords and can be life-threatening and present with noisy breathing. Aggressive treatment with steroids and/or various lasers is a treatment option.