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A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; 2011.

A.D.A.M. Medical Encyclopedia.

Hemangioma

Cavernous hemangioma; Strawberry nevus

Last reviewed: October 10, 2010.

A hemangioma is an abnormal buildup of blood vessels in the skin or internal organs.

Causes, incidence, and risk factors

About 30% of hemangiomas are present at birth. The rest appear in the first several months of life.

The hemangioma may be:

  • In the top skin layers (capillary hemangioma)

  • Deeper in the skin (cavernous hemangioma)

  • A mixture of both

Symptoms

  • A red to reddish-purple, raised sore (lesion) on the skin

  • A massive, raised tumor with blood vessels

Most hemangiomas are on the face and neck.

Signs and tests

Hemangiomas are diagnosed by a physical examination. In the case of deep or mixed lesions, a CT or MRI scan may be performed.

Occasionally, a hemangioma may occur with other rare conditions. Additional tests may be done for these syndromes.

Treatment

Superficial or "strawberry" hemangiomas often are not treated. When they are allowed to disappear on their own, the result is usually normal-appearing skin. In some cases, a laser may be used to remove the small vessels.

Cavernous hemangiomas that involve the eyelid and block vision are generally treated with steroid injections or laser treatments. These quickly reduce the size of the lesions, allowing vision to develop normally. Large cavernous hemangiomas or mixed hemangiomas may be treated with oral steroids and injections of steroids directly into the hemangioma.

Recently, lasers have been used to reduce the size of the hemangiomas. Lasers that emit yellow light damage the vessels in the hemangioma without damaging the skin over it. Some physicians use a combination of steroid injection and laser therapy.

Expectations (prognosis)

Small, superficial hemangiomas often disappear on their own. About 50% go away by age 5, and 90% are gone by age 9.

Complications

  • Bleeding (especially if the hemangioma is injured)

  • Problems with breathing and eating

  • Psychological problems, from skin appearance

  • Secondary infections and sores

  • Visible changes in the skin

  • Vision problems (amblyopia, strabismus)

Calling your health care provider

All birthmarks, including hemangiomas, should be evaluated by the health care provider during a routine examination.

Hemangiomas of the eyelid may interfere with the development of normal vision and must be treated in the first few months of life. Hemangiomas that interfere with breathing, feeding, or other vital functions should also be treated early.

Prevention

There is no known way to prevent hemangiomas.

References

  1. Habif TP. Vascular tumors and malformations. In: Habif TP, ed. Clinical Dermatology. 5th ed. St. Louis, Mo: Mosby Elsevier; 2009:chap 23.

Review Date: 10/10/2010.

Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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What works?

  • Treatments for strawberry birthmarks of the skin in infants and children Treatments for strawberry birthmarks of the skin in infants and children
    Infantile haemangiomas are soft, raised swellings on the skin, often with a bright, red surface. They are a non‐cancerous overgrowth of blood vessels in the skin. They are commonly known as 'strawberry birthmarks', 'strawberry naevi', or 'capillary haemangiomas'. They occur in five per cent of babies, with the majority appearing within the first few weeks of life, and reach their full size at about three to six months of age. The vast majority are uncomplicated and will shrink on their own by five to seven years of age and require no further treatment. However, some infantile haemangiomas may occur in high‐risk areas (such as near the eyes and nose which can result in impairment to vision and airway obstruction, respectively) and some of them are disfiguring and psychologically distressing to the children and their parents. Some may also develop complications so early medical treatment may be necessary. Corticosteroids are currently the standard treatment; however, it is not known which of a variety of treatments is best.
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Figures

  • Hemangioma - angiogram.
    Hemangioma on the face (nose).
    Circulatory system.

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Drugs of interest

  • Propranolol Oral
    Propranolol is used to treat high blood pressure, abnormal heart rhythms, heart disease, pheochromocytoma (tumor on a small gland near the kidneys), and certain types of tremor. It is also used to prevent angina (chest pain) and migraine headaches. Propranolol is also used to improve survival after a heart attack. Propranolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.
  • Vincristine
  • Bevacizumab Injection
    Bevacizumab is used with chemotherapy to treat cancer of the colon (large intestine) or rectum that has spread to other parts of the body. Bevacizumab is also used with chemotherapy to treat certain types of lung cancer. Bevacizumab is also used to treat glioblastoma (a certain type of cancerous brain tumor) that has been already treated with other medications. Bevacizumab is also used in combination with another medication to treat renal cell cancer (RCC, a type of cancer that begins in the kidney) that has spread to other parts of the body. Bevacizumab is in a class of medications called antiangiogenic agents. It works by stopping the formation of blood vessels that bring oxygen and nutrients to tumors. This may slow the growth and spread of tumors.
  • Imiquimod Topical
    Imiquimod cream is used to treat certain types of actinic keratoses (flat, scaly growths on the skin caused by too much sun exposure) on the face or scalp. Imiquimod cream is also used to treat superficial basal cell carcinoma (a type of skin cancer) on the trunk, neck, arms, hands, legs, or feet and warts on the skin of the genital and anal areas. Imiquimod is in a class of medications called immune response modifiers. It treats genital and anal warts by increasing the activity of the body's immune system. It is not known exactly how imiquimod cream works to treat actinic keratoses or superficial basal cell carcinoma. Imiquimod cream does not cure warts, and new warts may appear during treatment. It is not known whether imiquimod cream prevents the spread of warts to other people.

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