Vascular lesions can be generally categorized as either vascular tumors or vascular malformations. Some vascular lesions can be dangerous or severely disfiguring. Fortunately, most vascular lesions are not dangerous to your child and may be removed if desired. This page will focus on the most common lesions we see.
Although some vascular tumors are cancerous, the most common type of tumor - a hemangioma – is not. Hemangiomas are perhaps the most common type of benign, childhood vascular lesion. These lesions are the result of an abnormal growth of endothelial cells, the cells that line the inside of blood vessels. Typically, there is no obvious hemangioma at the time a child is born. Shortly after birth, however, a hemangioma may appear as a small red spot on the skin. The hemangioma then grows rapidly in the first months of life. Although the appearance and growth of a hemangioma may be very alarming to new parents, most hemangiomas begin to get smaller around a year of age. They continue to involute or decrease in size throughout childhood, and many resolve almost completely by the time a child is 7 or 8 years old.
The treatment of a hemangioma can vary, depending on the size, location and growth pattern of the lesion. When hemangiomas are detected early and grow rapidly, they may be treatable with a medicine called propranolol that is taken by mouth. For these rapidly growing lesions, propranolol has been shown to help slow growth. In some cases, it may even cause the hemangioma to regress or melt away. Propranolol therapy is most effective in the first months of life. For this reason, it is best to have your child evaluated as early as possible if a hemangioma is suspected. Rarely, when a hemangioma is large or growing in a way that is dangerous to your child, other treatments (such as corticosteroid or interferon therapy) may be recommended.
Because most hemangiomas gradually resolve over time, many do not require surgical treatment at all. Observation only may be the best treatment for many. Some children may benefit from early surgery for their hemangiomas, however. Surgical removal may be recommended for your child’s hemangioma if the hemangioma bleeds frequently, gets infected or develops a non-healing sore. Early surgery is also sometimes recommended if your child’s hemangioma is in an unfavorable place, such as the face, or if growth of the hemangioma is expected to distort or harm the growth of important, delicate structures such as the nose.
As your child’s hemangioma shrinks, there may be permanent, unfavorable changes in the texture or color of the skin where the hemangioma once was. Residual color changes often can be improved with laser treatment. Surgical removal of these residual changes may also be beneficial to address any residual skin texture changes. While there is little down-side to laser treatment, surgical removal will result in a scar. When considering surgical removal of a hemangioma in your child, it is important to decide whether the skin changes or discoloration are so burdensome that you are willing to exchange them for a surgical scar. If you are unsure whether surgery may be beneficial for your child, you should discuss your questions with a pediatric plastic surgeon with expertise in treating vascular lesions.
Vascular malformations are not tumors but abnormally formed blood vessels. These malformations can be comprised of arteries, veins, lymphatic vessels or any combination of these tissues. They are generally categorized as “high-flow” or “low-flow” lesions, depending on whether high-flow arteries are involved.
Unlike children with hemangiomas, children with vascular malformations are generally born with a clearly visible abnormality. These lesions don’t generally grow quickly but do have a tendency to grow slowly as your child grows. Small lesions may be amenable to surgical removal when your child is old enough to safely tolerate surgery. Larger lesions may be treated with a catheterization procedure, surgical excision or both. The treatment strategy and long-term outcome will vary, depending on the size, complexity, location and type of vascular malformation that your child has. Radiology studies, such as ultrasound or MRI, will give important information that will help your surgeon determine what treatment your child needs.
Vascular lesions may be simple or complex. What treatment your child needs will depend on the type, complexity and location of the lesion. We are happy to evaluate your child’s vascular lesion and recommend a treatment strategy designed to meet your child’s specific needs.