Haemangioma

Question 1

What is a haemangioma?

Answer 1

• = Benign tumour of blood vessels

- Also known as ‘strawberry birthmark’ or ‘strawberry naevus’

Question 2

Epidemiology of haemangioma: how common, M/F?

Answer 2

• Most common tumour in childhood
  • 1 in 10 babies
• Girls > boys

Question 3

Describe the natural history of a haemangioma.

Answer 3

• Mostly absent at birth, or is seen as a small red mark/pale patch
• Start growing within first few days of birth (can grow rapidly)
• Reach max size from 4-12mo approx
• Involution is gradual, and can take years to become flat (by around 5-8 yrs usually)
• Can disappear completely, but most often leave mark e.g. fatty lump/scar
• Most common on head and neck areas

Question 4

What are some possible complications/consequences of a haemangioma?

Answer 4

AEIOU:
- Aesthetic + psychosocial issues*
- Exanguination i.e. bleeding
- Infection 
- Obstruction and pressure: eye -> altered vision, larynx -> airway obstruction
- Ulceration*most common*
	• Surface skin is more fragile
	• Painful, slow to heal
	• Most common in those in nappy area

Question 5

Describe which haemangiomas might require treatment.

Answer 5

• Those of certain size on the face
• Threaten a vital organ e.g. eye - to prevent blindness, airway
• Other important areas e.g. nose, lips, ears, eyelids, nappy area
• Ulcerated haemangioma
• Psychosocial issues

Question 6

What kinds of treatment are there available for haemangiomas?

Answer 6

1. Propranolol (timolol for smaller) - need to screen and monitor BP, glucose (+ ECG at start)
2. Other Rx: cortisone, vincristine, IFN
3. Laser - esp early on and flat
4. Surgery - only later on when shrunken

Question 7

How do haemangiomas differ from vascular formations?

Answer 7

• Vascular malformation:
  ○ Not as common
  ○ Generally present at birth and grow with child
  ○ True birthmarks that remain for the rest of life
  - Similar Tx to haemangiomas
  ○ Examples - AVM, port-wine stain (capillary malformation), lymphangioma (lymphatic malformation)