An infantile hemangioma is a benign tumor of blood vessels, the most common tumor of infancy, that shows up in the first weeks of life. It grows fast for a few months and then slowly shrinks over years, but some need early treatment because of their site or size.
Key symptoms
- Not seen at birth, or only a faint mark, then appears in the first weeks
- Fast growth during the first 3 to 5 months
- Slow fading and shrinking over several years
- Some lesions break down with pain and bleeding, often in the diaper area
What you find on exam
- Superficial type: bright red, raised, lobulated plaque (strawberry mark)
- Deep type: soft bluish swelling under the skin
- Site matters: near the eye, lip, nose, beard area (airway) or diaper area
- Count lesions; 5 or more on the skin raises concern for liver hemangiomas
- Large segmental lesion on the face: think of PHACE syndrome
Tests
- Diagnosis is usually clinical, by history and appearance
- Ultrasound if the lesion is deep or the diagnosis is unclear
- Liver ultrasound if there are 5 or more skin hemangiomas
- MRI plus eye, heart and brain evaluation for large segmental face lesions
Treatment basics
- Most need only watchful waiting with photos to track growth
- Oral propranolol for high-risk lesions, given with feeds; refer early, ideally by 1 month of age
- Topical timolol for small, thin superficial lesions
- Ulcer care: barrier ointment, dressings and pain control
- Laser or surgery later for leftover skin changes
Red flags
- Lesion near the eye that could block vision
- Beard-area lesion with noisy breathing or stridor
- Ulceration, bleeding or many skin lesions
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.