What Is A Hemangioma?

As a parent it is troubling to see a tumor growing on your baby. It is important to understand that hemangiomas are usually non-cancerous and generally pose no physical threat to your child. In fact, they are the most common vascular anomaly in childhood and infancy.

The term hemangioma means blood (haema) vessel (angeio) tumor (oma). These benign tumors are caused by the swelling or growth of the cells that line blood vessels. Unlike other vascular anomalies that can be permanent, hemangiomas resolve on their own. They generally appear within the first two weeks of life on the face and neck, though they can appear anywhere on or in the body.

In a small percentage of children, hemangiomas can grow in areas such as the liver or around the throat, with life-threatening effects. They might also grow in areas that interfere with normal body functions, such as eating or urinating. In some cases, they can obstruct the development of hearing and seeing. Deeper hemangiomas might not be recognizable until your baby is about two or three months old.

Causes of Hemangioma

Hemangiomas are the most common benign tumor of infancy. There is nothing that happened to your baby during pregnancy that caused this growth, nor is there anything you can do to prevent future hemangiomas. Most infantile hemangiomas will appear in the first few weeks of life. They are more common in premature females weighing less than 2.2 pounds. In most cases of hemangiomas, there is no genetic link. Most parents want to know if their child will get another hemangioma. Eighty percent of babies will get only one.

Features of Hemangioma

The first sign of a hemangioma that parents tend to notice is a bright red spot that resembles a scratch; rather than healing, the apparent scratch gets bigger in size and volume. 

Hemangiomas in infants begin to appear within the first two weeks of life, though 30 to 40 percent of infants might show a lesion that is barely visible.

If the hemangioma is beneath the skin, the growth will appear bluish-purple. Many infants will also show a central bright-red area on top of a bluish-purple lump. Most likely, the hemangioma will grow in the head or neck region. They can, however, grow anywhere on or in the body.

If you think your baby has a hemangioma, your child’s pediatrician should be able to give a diagnosis through simple observation. Hemangiomas that are deeper, however, might require an MRI (Magnetic Resonance Imaging) scan. Large hemangiomas in the neck are also better studied with an MRI. Hemangiomas on the liver can be seen best with an ultrasound.

This should be used as a guideline. Not every symptom is included. If your child has one or more of these symptoms, it does not mean that he or she has a hemangioma. If you are concerned that your child might have a hemangioma, please make an appointment with your child's doctor.

Treatments for Hemangioma

With top surgeons and specialists from 18 clinical services within Yale, our craniofacial team offers comprehensive treatment for vascular anomalies for your child.

You are probably concerned about seeing a hemangioma on your baby, especially as it continues to enlarge. It is normal to wonder if your child will need surgery. In most cases, your pediatrician will take a “wait and see” approach. The infantile hemangioma generally continues to enlarge for 8 to 12 months before beginning to shrink on its own. As it resolves, the bright red color will begin to turn grey and white. The lump will soften and then shrink. Some hemangiomas can take up to seven years before they are fully resolved. Up to 70 percent of hemangiomas leave no visible mark.

In the remaining cases, hemangiomas can leave deformities, including extra skin, a change in skin texture, fatty scar tissue, and residual vessels. Such deformities are extremely common in the areas of the nose, lips, and cheeks. 

As a parent, you may wish to be more proactive and seek different treatment options to limit the growth of the tumor and speed the time it takes to resolve. It can be especially difficult to take a “wait and see” approach when the hemangioma is growing in a prominent and disfiguring location on your child, such as the nose or forehead.
There are generally four ways to interrupt the growth of hemangiomas:   
  • Laser treatment uses laser lights to restrict the blood flow to the tumor by targeting the abnormal blood vessels that cause the hemangiomas. Often the hemangioma will heal, but within a few weeks, it tends to grow back.
  • Steroids, which are given orally, may help accelerate shrinkage of the tumor. In rapidly growing tumors, sometimes, the steroid is applied topically or injected into the tumor site. 
  • Surgery is used to remove or reduce the hemangioma (or to revise the deformity left from a hemangioma once it has resolved).
During the planning stage of surgery, we use the most advanced 3D imaging techniques for a complete understanding of your child’s specific condition. By gathering accurate data, we can:
  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery
  • Follow and monitor your child’s condition during the post-surgical healing process
  • Monitor your child’s long-term development

In some cases, urgent treatment for hemangiomas is needed. Some of these vascular malformations are located around the eyes or in the airway near the vocal chords, which can be dangerous. Hemangiomas near the eye can cause permanent lazy eye and cornea distortion. Hemangiomas that constrict the airway can block your child from breathing. At times, hemangiomas can grow in the liver, causing stress to the heart. 

Other places of growth that may require surgery is when the hemangioma occurs in the salivary gland in front of the ear, because it can cause hearing loss. A tumor located on the lower back and pelvis may cause compression on the spinal cord. 

Some ulcerated hemangiomas may need medical attention, especially when they occur in the genital area where stool and urine irritate the open wound or if they bleed heavily from an open artery. 

Should your child need surgical treatment, you may be comforted to know that he or she will receive care from some of the top plastic and reconstructive specialists in the world here at the Yale Craniofacial Program.