Hemangiomas
What are the haemangioma/ birth mark?
Haemangioma are benign condition (noncancerous),
- Formed by an abnormally dense group of endothelial cells (the cells that normally line the blood vessels). The exact cause remains unknown.
- Occur in infants and more frequently in premature babies
- Growths appear in the first two weeks of life, then enlarge rapidly in first year, then slowly regress, and usually fully regress by 5 to 7 years age
- Some residual fatty tissue or thin skin may remain after involution
What are the vascular malformations?
- Vascular malformations are abnormal vascular channels, benign (non-cancerous) lesions
- They are present at birth incidentally, but may not become visible for weeks or months after birth
- Unlike haemangioma, they continue to grow slowly throughout life.
What are some of the types of vascular malformation?
There are several types of vascular malformations:
- Capillary (port wine stain) always present at birth as pink or purple skin patches
- Venous malformations are soft to the touch and the color disappears when compressed. They are most commonly found on the jaw, cheek, tongue and lips
- Lymphatic formed when excess fluid accumulates within the lymphatic vessels
- Arteriovenous abnormal connections between arteries and veins, resulting in a high flow, pulsating collections of blood vessels
Sometimes a combination of any of the four types may occur.
How Vascular Malformations and Hemangiomas look clinically?
Hemangiomas can be superficial or deep and most commonly have the following symptoms:
- Superficial hemangiomas appear as bright red, flat or raised patches on the skin
- Deep ones growing below the surface may not have an obvious outward appearance
- Both types are usually compressible to the touch
- They most often grow in the head or neck area, but they can involve any part of the body, including major organs
- Their size is variable and while most patients only have one lesion, multiple hemangiomas can occur
Vascular malformation symptoms are highly variable and depend on the type, size and location of the malformation. Symptoms may be absent altogether or life threatening if it’s an arteriovenous malformation (AVM).
- What are diagnostic modalities to diagnose lesions?
Most hemangiomas are easily identified without any diagnostic testing. Deeper lesions may require MRI/ Ultrasound, some times CT.
How hemangiomas are managed?
Most hemangiomas are small and non-problematic and may not require treatment. But they need regular monitoring especially if it is obstructing vital structures such as eyes or throat, or if it bleeds.
The hemangiomas can be managed by
- Steroid or other drugs
- Surgical removal
- Embolization of the blood vessels (injection of material into the blood vessels to block the blood inflow)
How vascular malformations are managed?
- For port wine stain (capillary malformation) laser therapy is usually recommended
- Arterial malformations are often treated by embolization (blood flow into malformation is blocked by injecting material near the lesion) followed by with or without surgery
- Venous malformations are usually treated by direct injection of a sclerosing (clotting) medication, which causes clotting of the channels
Most often, a combination of nonsurgical and surgical method is used for effective management of the vascular anomaly.