The presentation and management of hemangiomas

LEARNING OBJECTIVES:: After studying this article, the participant should be able to: (1) Define what is meant by either a classic (infantile) or atypical hemangioma and understand the natural history of each. (2) Identify the common phenotypic, histologic, and radiographic findings of a hemangioma. (3) Know the potential complications associated with hemangiomas. (4) Outline the options available to treat a hemangioma. BACKGROUND:: Hemangiomas represent the most common tumors of infancy. These lesions maintain unique patterns of growth, sequelae, and therapeutic modalities from other vascular birthmarks. Until recently, however, classification schemes based on historical phenotypic observations often complicated diagnosis and proper medical management. METHODS:: Mulliken and Glowacki redefined the identification of these lesions by correlating clinical, histological, and autoradiographical data from a series of patients with vascular marks. A formal classification was officially adopted by the International Society for the Study of Vascular Anomalies in 1996 to structure a clinically relevant classification system. RESULTS:: Under the adopted parameters, hemangiomas are classified as a subset of vascular tumors and delineated from vascular malformations. Generally, a hemangioma experiences a phase of rapid growth and expansion followed by slow, but steady, regression. The life cycle can be divided into the proliferating phase, involuting phase, and involuted phase, with each distinct in its time course and histological, radiographic, and molecular findings. Rarely, hemangiomas with an atypical presentation arise, and the clinician must be aware of their existence to avoid incorrect intervention and to prepare for possible life-threatening sequelae. CONCLUSIONS:: The frequency of vascular marks in the general population makes it likely that a plastic surgeon will be involved in treatment of an affected patient at some point in his or her career. The goal of this article is to distinguish hemangiomas from other vascular marks by highlighting their presentation, possible complications, and common treatment modalities to aid diagnosis and therapeutic planning for this common vascular tumor.