Hemangioma Excision Health Article

Definition

Hemangioma excision is the use of surgical techniques to remove benign tumors made up of blood vessels that are often located within the skin. Strawberry hemangiomas are often called strawberry birthmarks. Hemangioma surgery involves the removal of the abnormal growth in a way that minimizes both physical and psychological scarring of the patient.

Purpose

Almost all hemangiomas will undergo a long, slow regression, known as involution, without treatment. The end result of involution is potentially worse than the scarring that would occur with surgery. Thus, surgical intervention is commonly indicated only if the growth of the tumor is life threatening or highly problematic from a medical or psychosocial point of view. For example, tumor growths that affect the ability of the eye to see, the ear to hear, or the passage of air in and out of the lungs are frequently candidates for surgical treatment. Tumors that have ulcerated are also common candidates for surgical treatment. Surgery after involution can be used to remove remaining scar tissue.

Although controversial, some surgeons also recommend surgery before or during the involution process, in an attempt to minimize the final cosmetic deformity. Small lesions that are in areas that can be excised without cosmetic or functional risk are particularly well-suited to early surgical treatment.

Demographics

Hemangiomas are the most common tumor of infancy, occurring in approximately 10–12% of all white children and are nearly twice as common in premature infants. For unknown reasons, the occurrence in children of black or Asian background is much lower, approximately 0.8–1.4%. The tumors have been reported to be from two to six times more common in females than in males. The great majority of these tumors are located in the head and neck, with the remaining appearing throughout the body, including internally.

At present, an estimated 60% of patients with hemangiomas require some form of corrective surgery sometime during recovery from the tumor surgery. The remaining 40% rely on the spontaneous involution process to resolve the lesion, although complete return to normalcy is extremely rare.

Description

Hemangiomas undergo a characteristic set of stages during the tumor development. Approximately 30% are present at birth, with the remainder appearing within the first few weeks of life, often beginning as a well-demarcated pale spot that becomes more noticeable when the child cries. The tumors are highly variable in presentation and range from flat, reddish areas known as superficial hemangiomas, to those that are bluish in color and located further under the skin, and are known as deep hemangiomas.

During the first six to 18 months of life, hemangiomas undergo a stage where they grow at an excessive rate in size due to abnormal cell division. The final size of the tumors can range from tiny, hardly noticeable red areas to large, disfiguring growths. In almost all hemangiomas, a long, slow involution process that follows the proliferation stage can take years to complete. Among the first signs of the involution process is a deepening of the red color of the tumor, a graying of the surface, and the appearance of white spots. In general, 50% of all hemangiomas are completely involuted by age five, and 75–90% have completed the process by age seven.

Once a decision to treat a hemangionma with surgery is made, the exact technique to be utilized must also be determined. The most commonly used technique for small lesions is very straightforward and involves removing the abnormal vascular tissue with a lenticular, or lens-shaped excision, that results in a linear scar. Recently, some surgeons have been advocating the use of an elliptical, circular, or irregular incision shapes, followed by a purse-string-type closure. This technique does result in a scar having radial (starshaped) ridges that can take several weeks to flatten. However, the overall result is a shorter scar that can be followed up by removal, using the lenticular excision technique.

Larger, more extensive lesions may require angiography, a process that maps the path of the vessels feeding the lesion, and embolization, the deliberate blocking of these blood vessels using small particles of inert material. This process is followed by complete removal of the abnormal tissue.

Depending on the size and nature of the tumor, the excision surgery can be done on an outpatient or inpatient basis. For very small lesions, local anesthetic may be sufficient, but for the great majority, general anesthesia is necessary to keep the patient comfortable.