Haemangiomas are the most common soft tissue tumours of infancy. They are benign tumours that occur as a result of dysregulation of vasculogenesis and angiogenesis leading to a proliferation of blood vessels. The prevalence of haemangiomas in newborns is 4-10%.
Haemangiomas may be present at birth or may appear during the first few weeks of life. After a latent period of 1-3 weeks they will then start to proliferate.
Different types of haemangioma:
- Superficial infantile haemaniomas are located in the upper dermis and appear as elevated red papules, nodules or plaques.
- Deep infantile haemangiomas extend to the adipose tissue and appear as a bluish lump.
- Mixed haemangiomas have a strawberry naevus overlying a bluish swelling
- Segmental proliferative haemangiomas involve a larger neuroectodermal unit and can be large and cosmetically disfiguring. They are plaque-like and usually have a dermatomal distribution. They may be associated with other congenital abnormalities e.g. PHACE syndrome, PELVIS syndrome
Most haemangiomas do not require treatment and will gradually involute.
Complications occur in approximately 12% of cases and it is important to be aware of the criteria for referral to Dermatology for treatment:
- Located near the eyes
- Haemangiomas located around the neck (increased risk of an airway haemangioma)
- Haemangiomas causing obstruction of obstruction of the nose or external auditory canal
- Cosmetically sensitive areas e.g face, lips
- Areas important for function e.g hands/fingers, anogenital region
- Ulceration of a haemangioma (white discolouration at the margins of the haemangioma with pain)
- Segmental haemangiomas (increased risk of disfigurement and other underlying conditions, decreased chance of spontaneous resolution)
- Multiple haemangiomas (increased risk of visceral haemangiomas)
If treatment is required, propranolol is the 1st choice.
Superficial infantile haemangioma
Superficial Infantile haemangiomas (SIH) are benign tumours that occur as a result of dysregulation of vasculogenesis and angiogenesis leading to a proliferation of blood vessels. SIH are located in the upper dermis and appear as elevated red papules, plaques or nodules.
SIHs may also be called capillary haemangioma, capillary naevus, strawberry haemangiomas, strawberry naevus and haemangioma simplex.
Over 80% of infantile haemangiomas occur on the head and neck.
A strawberry haemangioma is another name for a superficial infantile haemangioma. The name is usually applied to the more elevated, fleshy haemangiomas that appear like a strawberry embedded in the skin.
Munden A, Butschek R, Tom WL, Marshall JS, Poeltler DM, Krohne SE, et al. Prospective study of infantile haemangiomas: incidence, clinical characteristics and association with placental anomalies. Br J Dermatol [Internet]. 2014 Apr 1 [cited 2020 Aug 23];170(4):907–13. Available from: https://doi.wiley.com/10.1111/bjd.12804
Infantile proliferative haemangioma | DermNet NZ [Internet]. [cited 2020 Aug 23]. Available from: https://dermnetnz.org/topics/infantile-haemangioma/
Léauté-Labrèze C, Harper JI, Hoeger PH. Infantile haemangioma [Internet]. Vol. 390, The Lancet. Lancet Publishing Group; 2017 [cited 2020 Aug 23]. p. 85–94. Available from: https://pubmed.ncbi.nlm.nih.gov/28089471