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Vascular Malformations and Hemangiomas

What is a hemangioma?

A hemangioma is a type of birthmark. It is the most common benign (noncancerous) tumor of the skin. Hemangiomas may be present at birth (faint red mark) or may appear in the first months after birth. A hemangioma is also known as a port wine stain, strawberry hemangioma, and salmon patch. About 60 percent of hemangiomas occur in the head or neck area. Hemangiomas occur at least three times more often in females than in males. Most will continue to grow for the first six to 12 months of life before beginning to shrink. 

What is a vascular malformation?

A vascular malformation is another type of birthmark, or congenital (present at birth) growth, made up of arteries, veins, capillaries, or lymphatic vessels. There are several different types of malformations and they are named according to which type of blood vessel is predominantly affected. A vascular malformation is also known as lymphangioma, arteriovenous malformation, and vascular gigantism.

What is the difference between a hemangioma and a vascular malformation?

Most hemangiomas are not usually present at birth or are very faint red marks. Shortly after birth, however, they grow rapidly--often faster than the child's growth. Over time, they become smaller (involute) and lighter in color. The process of involution may take several years.

Vascular malformations are present at birth and enlarge proportionately with the growth of the child. They do not involute spontaneously and may become more apparent as the child grows.

What causes hemangiomas and vascular malformations?

The cause for hemangiomas and vascular malformations is usually sporadic (occurs by chance). However, they can also be inherited in a family as an autosomal dominant trait. Autosomal dominant means that one gene is necessary to express the condition, and the gene is passed from parent to child with a 50/50 risk for each pregnancy. Males and females are equally affected and there is great variability in expression of the gene. In other words, a parent may unknowingly have had a hemangioma because it faded, but the child is more severely affected. The family may not come to the attention of a geneticist until the birth of the child with a more severe condition. Other relatives with mild expression of the gene are often discovered at that time, confirming autosomal dominant inheritance.

Hemangiomas and vascular malformations are a manifestation of many different genetic syndromes that have a variety of inheritance patterns and chances for reoccurrence, depending on the specific syndrome present.

What should I do if my child has a hemangioma or vascular malformation?

If a hemangioma or vascular malformation is very large or affects the breathing system (airway or lungs) or another large organ system, it could be life-threatening. If a hemangioma has uncontrollable bleeding, this could also be life-threatening. Depending on where a hemangioma or vascular malformation is, it may cause physical problems, such as with moving a part of the body or difficulty seeing. Large and/or life-threatening lesions should be evaluated by a multidisciplinary team of specialists that includes plastic surgeons, dermatologists, ophthalmologists, radiologists, and other specialists, depending on what organs are involved.

Treatment for hemangiomas

Treatment for hemangiomas depends on their size, location, and severity. Treatment is usually not recommended for small, noninvasive hemangiomas, since they will become smaller (involute) on their own. However, hemangiomas that cause bleeding problems, feeding or breathing difficulties, growth disturbances, or impairment of vision may require medical or surgical intervention.

Treatment may include the following:

  • Steroid medications

  • Embolization of the blood vessels (injection of material into the blood vessels to block the blood inflow)

  • Laser or surgical removal

Treatment for vascular malformations

Treatment for vascular malformations depends on the type of the malformation. Each type of malformation is treated differently. Laser therapy is usually effective for capillary malformations or port wine stains, which tend to be flat, violet or red patches on the face. Arterial malformations are often treated by embolization (blood flow into malformation is blocked by injecting material near the lesion). Venous malformations are usually treated by direct injection of a sclerosing (clotting) medication which causes clotting of the channels. Most often, a combination of these various treatments is used for effective management of the lesion.

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