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About Us |
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Patient Education |
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Photo Gallery |
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The ASPS
Patient Photo Gallery currently includes
before and
after surgery pictures. |
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Hemangioma |
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Hemangiomas are
strawberry-colored "birthmarks". They are not rare, and vary from
tiny blebs to large and multiple tumor-like growths. They are not
true birthmarks since they are mostly not seen at birth, but start
in infancy and then begin to grow. Hemangiomas first appear from
birth up to 18 months, and then slowly shrink. Port wine stains and
other true birthmarks are fully formed at birth and do not grow
wider.
Doctors disagree over how hemangiomas should be dealt with. The
answer may depend on whether you see a dermatologist, plastic
surgeon or other specialist. Because many of the smaller birthmarks
resolve on their own with no intervention, most doctors agree that
you should leave small hemangiomas that are not growing alone,
especially if they are on skin normally covered by clothing.
Hemangiomas that require early aggressive treatment include those
that are cosmetically deforming, growing rapidly or obstructing
vision, hearing, breathing, eating or any other body function.
Hemangiomas on the lower face and neck may later block internal
airways. Large facial hemangiomas may cause psychosocial impairment.
Also, larger hemangiomas that are left alone to regress (shrink away
over years) will eventually look better if the resulting saggy,
stretched out skin and fatty tissue is surgically removed.
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What is a hemangioma? |
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The word hemangioma comes from the
Latin words hemangio meaning blood vessel and oma
meaning tumor with active cell dividing activity. Hemangiomas differ
from other vascular birthmarks in that they are biologically active,
their growth is dependent from the growth of the child. They are the
most common benign tumor of infants. Hemangioma growth is referred
to as Hyperplasia, where as other vascular birthmarks growth
is referred to as Hypertrophy. |
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Who gets hemangiomas? |
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1 in 100 children each year will be born with a vascular birthmark that requires the
opinion of a specialist (40,000). Most hemangiomas appear within a
week or two after birth. Hemangiomas are up to 5 times more common
in girls than boys.They occur more frequently in
premature infants. |
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Where do hemangiomas occur? |
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Hemangiomas are most often found on
the head or neck (up to 80%), however, they may occur anywhere on
the skin or internal organs. Children can develop a single lesion or
they can have a dominant primary lesion with smaller associated
hemangiomas. There can be an internal lesion with no associated
lesions on the outside. Some children present with several small
visible hemangiomas this may be indicative of a large hemangioma of
the liver or GI tract. Any child with 3 or more cutaneous lesions
should be evaluated by ultrasound to rule out internal lesions.
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How are the doctors treating
hemangiomas? |
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Up until recently
uncomplicated hemangiomas were observed. This practice was based on
research information from as far back as 1928, and was in large part
due to the fact that there was no dictable treatment option
available to physicians. It was hoped that most lesions would
involute ( become smaller) on their own. About 50% will involute by
age 5. However; those that do not involute by age 3-5 may take up to
10 years to resolve and will in general leave residual scaring
requiring surgery. Most doctors are trained to have the patient
wait, since in the past surgery most likely would leave scaring. Due
to the advances in plastic surgery and the development of new laser
technology many doctors are recognizing the benefit of early
intervention even for uncomplicated hemangiomas. Many parents would
rather deal with a small surgical scar then a large purple tumor.
Today treatment options include surgical excision, laser treatments,
steroid and or alpha interferon therapy and rarely embolization or
scelerotherapy. Because data on this subject has been incomplete
until now, parental pressure and the new treatment options are
allowing knowledgeable physicians to abandon the benign neglect
theory and selectively intervene as early as the neonatal period.
Laser and steroid treatment have been successful in arresting the
growth of hemangiomas in the first few weeks of life. Without
intervention a hemangioma could continue to grow for one year.
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What are the complications of
hemangiomas? |
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There are two general categories of
complications arising from hemangiomas. Absolute indications for
treatment due to complication include visual obstruction, airway
obstruction or aural (ear) canal obstruction, significant visceral
involvement or a large hemangioma causing high output heart failure.
Relative indications for treatment include ulcerations, bleeding,
pain and possibility of permanent facial disfigurement. Hemangiomas
located in the perianal or genital areas may become infected or
develop cellulitis. Lesions greater then 5 cm in diameter may be
associated with platelet trapping (Kasabach-Merrit Syndrome).
Infants presenting with 3 or more small hemangiomas should be
evaluated for internal hemangioma of the liver or digestive tract.
Visceral hemangiomas can lead to congestive heart failure or other
organ dysfunction. All hemangiomas must be evaluated by a specialist
to prevent complications from developing.
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What will happen if my child has a
hemangioma? |
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Typically the hemangioma appears
within 2 weeks after birth. Only 2% are actually visible at birth.
It is usually noticed as a small red blemish or bump, most parents
interpret it as a bruise or scratch but quickly become alarmed as it
begins to rapidly grow. Current research indicates two growth
cycles: 0-4 months for the first cycle, with a pause from 4-6 months
and then a second growth, from 6 months - 1 year or sometimes
longer. Between 12 months and 18 months of age, some areas may begin
to show graying; indicating the Involution Phase. Many parents will
notice a Rapid Regression of the lesion. Other parents note minor
graying; indicating Slow Regression of the lesion. If the regression
is rapid, the lesion will generally be gone by age 3-5 years of age,
with none or only minor residual scaring. Otherwise; involution may
take many years, following the 10% rule. 50% will involute by age 5,
70% by age 7, and 90% by the age 9. However, lesions which regress
slowly generally leave scaring, atrophoderma (thinning of the skin),
vascular stria, or contour irregularities of the skin. These
children will need some type of corrective surgery. |
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What do I do if my child has a
hemangioma? |
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Unfortunately it is not possible to
predict which hemangiomas will in volute quickly or which will
develop complications. Therefore, it is important to have each child
evaluated by a physician specializing in hemangiomas. Many of the
Children's Hospitals have Vascular Birthmark programs consisting of
multi specialty clinics experienced in the management and treatment
of hemangiomas. These programs may include the disciplines of
plastic surgery, dermatology, hematology, radiology and
otolaryngology. In addition there are many informational and support
groups networking to assist families in making the best choice for
their child. Hemangioma News line can assist you in finding the best
care for your child.
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New Page 1
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About Surgery |
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Areas of
surgery |
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Planning your surgery |
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