Diagnosis of Hemangiomas
The following gives guidelines for lay people to assess their child and is not a substitute for a skilled physician’s evaluation.
Hemangiomas are the most common tumor of the neonatal period involving ~ 2.6% of all newborns, ~ 10% of caucasian newborns and ~25% of premature newborns < 1,000 gms. Most children with hemangiomas are female, there is about a 5:1 preponderance of females to males. Most hemangiomas are either not at all visible at birth or are seen as a slight red blush of the skin after birth. Hemangiomas generally present themselves several weeks after birth when the “proliferative” stage of these lesions begins. The proliferative phase is characterized by a variable rate of growth of the lesion that can last between 12 to 18 months. The rate of growth varies greatly but in general the larger the surface area of the hemangioma the greater potential there is for growth. It is during this phase that the hemangioma can ulcerate and lead to permanent scarring as well as potentially destroy surrounding normal tissue, especially involved cartilage. After the proliferative phase the hemangiomas enter the “involution” phase during which the hemangioma tumor cells undergo what is known as “apoptosis” which in simple terms means that the dividing hemangioma cells cease dividing and die and are absorbed back into the body. Involution can occur fairly quickly (over a period of several months to a year) or can proceed slowly over several years. Should the hemangioma get through the proliferative phase without too much growth and there is little to modest volume associated with the lesion and no complications such as ulceration and scarring (among others) it is possible for the lesion to involute over time and leave little if any residual signs. Other hemangiomas will leave permanent scarring, tissue deformity or destruction and/ or stria formation with atrophoderma (this skin with small spider veins) as unwanted sequela. Hemangioma treatment should help decrease the risk of these problems and/or lessen them. When to treat is very much an individual assessment based on size, location, rate of growth and other factors.
Treatment of Hemangiomas
The mainstay of medical treatment for hemangiomas at present is the use of various beta blockers which have been shown to stunt or slow down growth of hemangiomas. In my practice I use local pediatric oncologists skilled in the use of these drugs. Proper referrals are available upon request. Surgical intervention for the treatment of hemangiomas is done by Dr. Freeman and involves the use of laser and/or surgical excision depending on each individual patient. In general laser intervention is used to decrease the growth potential of hemangiomas and/or strengthen the thin covering of the surface of hemangiomas. Lasers used to accomplish this include the diode, q-switched KTP and the pulsed dye laser. In particular the diode laser is used to perform ILA (intralesional laser ablation) which is a technique that Dr. Freeman has perfected over the years that allows him to insert the laser energy into the bulk of the hemangioma and destroy the dividing abnormal hemangioma cells within the lesion thereby decreasing the ability of the hemangioma to continue growth. Surgical excision of the hemangioma is on a case by case basis but in general is used as a last resort or a final step.