A hemangioma of the skin is an abnormal buildup of blood vessels on or under the surface of the skin. A hemangioma of the skin may look like a red wine- or strawberry-colored birthmark and may protrude from the skin. Hemangiomas of the skin appear most frequently on the face and neck and behind the ears.
Growths in the outermost layers of skin are called capillary hemangiomas, while those deeper in the skin are called cavernous hemangiomas. Capillary hemangiomas are often left untreated, but cavernous growths should be treated if they interfere with eyesight or breathing or are very unsightly.
Hemangiomas of the skin generally develop during infancy. They can affect both boys and girls.
Hemangiomas look painful, but rarely cause any discomfort. After a brief period of rapid growth, they often shrink and go away on their own without treatment. Hemangiomas of the skin are non-cancerous and complications are very rare.
Experts do not know why these benign tumors form. However, according to the Children’s Hospital of Wisconsin, they are more common in:
- low birth weight infants
- premature infants
- infants of Caucasian background (CHW)
In some cases, hemangiomas appear to run in families. However, they can also appear spontaneously—so there may or may not be a genetic component to the condition. Because their exact cause remains unknown, there is no way to prevent hemangiomas of the skin.
Hemangiomas of the skin are generally deep red or purple and appear as raised lesions or tumors on the skin. The deeper the hemangioma, the darker it appears in color. Growths on the skin’s surface (strawberry or capillary hemangiomas) are usually deep red. Growths under the skin’s surface (cavernous hemangiomas) appear as blue or purple spongy masses filled with blood.
Hemangiomas are usually small, but can grow to be quite large. Hemangiomas of the skin normally begin as small scratches or red patches on the skin that form during the first two or three weeks of life. Hemangiomas in infants tend to grow rapidly for the following four to six months.
After this period of growth, hemangiomas enter a resting phase. They should remain the same size for several months or years and then begin to shrink. According to the National Institutes of Health, half of all hemangiomas disappear by age five and 90 percent are gone by age nine (NIH, 2010).
Hemangiomas of the skin are usually diagnosed just by looking at the skin. In general, no other testing is needed. If a growth appears to be abnormal or there are other sores present, your doctor may order blood tests or a skin biopsy (removing a small piece of skin for laboratory testing).
Cavernous hemangiomas may be examined using an MRI or CT imaging scan. These scans allow doctors to visualize structures beneath the skin to see how deep the hemangiomas have grown.
Doctors may also use a Doppler ultrasound to see how blood is flowing through a hemangioma. This allows them to distinguish between a hemangioma and other, similar looking lesions, such as those caused by rubella, measles, or acrodermatitis. A Doppler ultrasound may also help doctors determine if the hemangioma is growing, resting, or shrinking.
Capillary hemangiomas are usually not treated. As the child gets older, the growth tends to shrink and will usually disappear on its own.
If a cavernous hemangioma is in an area that could interfere with sight or breathing (around the eyes, nose, or throat), treatment may be necessary. Treatment might also be required if the hemangioma is very large or ulcerates (breaks open and bleeds), causing discomfort.
Treatments are aimed at shrinking or removing the growth. Laser surgery can be used to remove a large hemangioma of the skin that is uncomfortable or is causing any problems. Laser treatments can also be used to reduce remaining discoloration after a hemangioma has healed.
If the hemangioma is growing quickly, corticosteroids such as prednisone can be used to slow or stop the growth. They may be given orally, applied topically, or injected into the hemangioma. The potential side effects of these medications are serious and may include poor growth, high blood sugar and blood pressure, and cataracts.
A medication called vincristine, which is used to treat other types of tumors, is also sometimes used to treat hemangiomas that interfere with sight or cause breathing problems. According to the Children’s Hospital of Wisconsin, it is usually given as a monthly injection (CHW).
Complications from hemangiomas are extremely rare. However, they can occur if a hemangioma grows very quickly or in a dangerous location. Potential complications include:
- ulceration (bleeding)
- vision changes (if the hemangioma is on the eye)
- difficulty breathing (if the hemangioma is large and on the throat or nose)
- secondary infection