Infantile hemangiomas are non-cancerous vascular tumors. They are abnormal growths of cells that line the inner surface of blood vessels (endothelial cells). They are the most common tumor of childhood. Hemangiomas occur in about 1 in every 20 infants. Hemangiomas happen more often in premature infants and multiple births like twins and triplets.
Infantile hemangiomas may be visible at birth or may not be recognized until the first few weeks or months of life. Most hemangiomas are noted by 2 to 3 weeks of age. They can occur in any area of the body, but the head and neck are the most common. Some lesions are small and barely visible. Others are large and very easy to see. Most individuals only have one hemangioma, but some patients have multiple.
The cause of hemangiomas is not fully known. They are not related to drugs or medications that may have been taken during pregnancy. They are not related to any environmental exposures that may have occurred during that time. Hemangiomas are not inherited.
Typically, infantile hemangiomas first have a period of growth (called the proliferative phase). This is followed by a period of shrinkage (called the involutive phase). Most hemangiomas begin their growth phase shortly after birth. This phase usually lasts for four to nine months (average six months). Each lesion grows at a different rate. The involutive phase is much slower and can take up to 10 years (when not treated). Most hemangiomas go away completely. Some hemangiomas do not shrink completely and may leave extra skin or fatty tissue, skin discoloration or telangiectasias (tiny blood vessels of the skin).
Infantile hemangiomas are different than congenital hemangiomas. Congenital hemangiomas are fully grown at birth and do not increase in size like infantile hemangiomas.
Infantile hemangiomas are grouped as superficial, deep or combined. If the lesion is near the skin surface, it is called a superficial hemangioma. If it grows under the skin, it is considered a deep hemangioma. When it has components of both superficial and deep lesions, we call this a combined or mixed hemangioma.
Superficial lesions appear as bright red, raised or flat patches on the skin. They may also have a textured area that looks like a strawberry. Blood vessels coming from the lesion may be visible on or beneath the skin.
Deep hemangiomas appear a mass or “bump” with a blue or purple color. Deep hemangiomas may not be noticed for many weeks or months after birth since they are located under the skin.
Combined lesions may have a layered combination of a red lesion on top of a blue-purple mass under the skin. As hemangiomas shrink, they change in texture and color. Over time, they become softer, flatter and less red. Usually, the skin appears normal or nearly normal when the hemangioma goes away completely.
A diagnosis is made by medical history and physical examination. Ultrasound can be used to confirm the diagnosis but frequently is not needed. Sometimes, magnetic resonance imaging (MRI) or computed tomography (CT or CAT scan) is performed. Only in rare circumstances, biopsy of a lesion is needed to confirm a diagnosis.
The most common short-term complication is ulceration (skin breakdown). Ulceration causes pain and may lead to skin infection. Bleeding may also occur with ulcerations. This usually only lasts a brief time and can be controlled with gentle continuous pressure. Depending on the size and location of the hemangioma, other complications may occur such as distortion of facial features and / or problems with vision or breathing.
Certain patterns of hemangiomas are more problematic. They are more likely to cause complications. Children with these challenging hemangiomas (listed below) should be evaluated by a pediatric specialist with expertise in management of infantile hemangiomas.
Most infantile hemangiomas shrink completely and do not require treatment. Treatment recommendations are based on patient age, size and location of the hemangioma, and any current or potential complications.
Left over fatty tissue or skin telangiectasias may remain after the hemangioma has shrunk or disappeared. Surgery and / or laser therapy may be suggested at that time.
Management options include observation (no treatment but close monitoring), drug therapy, laser therapy and surgical removal. A combination of treatments may also be used.
There are certain risks or side effects to each treatment.
Our Hemangioma and Vascular Malformation Center is one of the largest comprehensive vascular anomaly centers in North America. Our team has deep experience and expertise and treats patients from around the country and the world.
Last Updated 01/2025
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