What do congenital hemangiomas look like?

Congenital hemangiomas are most often found in the head and neck area or the limbs but may also occur on the trunk. Internally they are most often found in the liver.

These tumors can be flat or look like raised growths from the skin. They are typically blue-purplish in color. They also have some red telangiectasias (small blood vessels) and surrounding pallor (“halo” of paleness). Some congenital hemangiomas have visible veins in or around the lesion.

There are different types of congenital hemangiomas:

• Rapidly involuting congenital hemangiomas (RICH): These lesions begin to involute (disappear) soon after birth. These will continue to get smaller in size during the first year of life. Most have significantly shrunk by 18 months of age. However, the majority of individuals with a RICH will have some lasting skin changes.
• Non-involuting congenital hemangiomas (NICH): These lesions are fully developed at birth. They do not involute or decrease in size over time.
• Partially involuting congenital hemangioma (PICH): These lesions initially have a rapid decrease in size. This happens within the first 12 months of life. Unlike RICH, the rate of involution (disappearing) decreases over time. The main part of the lesion does not completely go away.

How are congenital hemangiomas diagnosed?

In most cases, a diagnosis is made by connecting medical history with a physical examination. If there is any question of the diagnosis, radiologic imaging with ultrasonography, magnetic resonance imaging (MRI) or computed tomography (CT or CAT scan) may be needed. These tools can also help determine the size of the lesion.

If there is any concern for a possible malignant (cancerous) growth, a biopsy will be done. This involves a surgical procedure to take out a small section of tissue from the lesion for examination by a pathologist. Sometimes, the surgeon will remove the entire lesion.

What are the possible complications?

Complications of congenital hemangiomas are uncommon. Complications occur most frequently in RICH type hemangiomas. This may happen more often if they are large in size or involve an internal organ like the liver.

Large congenital hemangiomas can cause skin breakdown and very rarely heart failure.

When RICH type hemangiomas are rapidly going away, a child may develop low platelets and clotting factors for a short time (about two weeks). Usually this does not cause bleeding issues. Some individuals report pain or discomfort in the affected area during puberty.

Should my child receive treatment?

A multidisciplinary pediatric team that specializes in treating hemangiomas should examine your child.

Decisions to treat these congenital hemangiomas must be made on an individual basis. The team considers potential complications such as heart failure, ulceration and / or bleeding, activities of the child and prevention of permanent disfigurement.

How are congenital hemangiomas managed?

Decisions to treat these congenital hemangiomas must be made on an individual basis. The team considers such things as:

• Observation: In most cases, continued observation is the best course to follow. This is best if the congenital hemangioma is not effecting a child’s ability to function.
• Drug Therapy: There are no medications that shrink congenital hemangiomas. The medications used to treat infantile hemangiomas do not work for congenital hemangiomas.
• Surgery: Surgery may be needed for complicated congenital hemangiomas. Hemangiomas in the liver and those that are causing problems with bleeding, heart failure, or functional compromise may need surgery. Surgery may be necessary even after regression of the hemangioma to reduce loose skin or scarring.