Hemangioma

An infantile hemangioma (IH), often known as a strawberry nevus, usually appears after birth. It is most commonly noticed at a few days of life. It may be superficial, mixed or deep. There are usually 3 phases of growth. The first being a rapid growth or proliferative phase at around 5 to 8 weeks. The next phase is a resting or plateau phase occurring at around the first year of life. Last of which, is the involution phase.

There are 2 other hemangiomas which do not follow the above classical phases of growth. They are namely the rapidly involuting congenital hemangioma (RICH) and non- involuting congenital hemangioma (NICH). The former is fully formed at birth, then involutes spontaneously and resolves by the child’s first or second birthday. The latter is fully formed at birth but does not involute and shrink.

When do we worry?

Most of these infantile hemangiomas do not need treatment and we can observe for spontaneous involution. However, do seek EARLY treatment if the following are present:

1. Ulceration, bleeding or pain
2. Locations that may affect function such as being near or at the eyes, lips, nose, ears, jawline, diaper area, scalp especially if > 2 cm
3. Segmental involvement of the face (may need to evaluate for PHACES syndrome -posterior fossa malformations, hemangiomas, arterial abnormalities, cardiac abnormalities, eye abnormalities, sternal cleft defect) or over the lower back or perineum (LUMBAR syndrome – Lower body hemangioma, urogenital anomalies, myelopathy, bony deformities, anorectal anomalies, renal anomalies or PELVIS syndrome – Perineal hemangioma, external genital malformations, lipomyelomeningocele, vesicorenal abnormalities, imperforate anus, skin tag)
4. Multiple > 5 (will need screening liver ultrasound, if multiple liver IH, will need to check for hypothyroidism)
5. Concern about cosmesis