(he-man’ji-o’mah)-A mass created from the proliferation of blood vessels. The first sign of this is a red or blanched spot known as a herald spot which was not present at birth. This spot rapidly grows at a rate faster than the general growth rate of the child. After the phase of rapid growth is completed the color begins to fade & central area(s) of pallor develop. This heralds the beginning of involution or resolution. They do not usually invade adjacent structures such as bone or muscle. By age 5 about half of these children have had full resolution & by age 7 about 75% of these children. The speed & completeness of resolution are independent of hemangioma size, location or initial growth rate. However, the earlier resolution begins & the more rapidly it occurs the more complete it is.
Resolution may be incomplete & if even complete may leave behind unsightly damaged skin. The classic approach was to do nothing but wait for resolution the thought being that the high percentage of complete resolution was better than risking the chance of scarring after excision. The exceptions were early treatment of ulcerated bleeding hemangiomas or those obstructing vital organs such as the anus, mouth, ears, eyes or respiratory pathways. Rarely the larger hemangiomas can trap blood components giving rise to dangerous bleeding tendencies. The emergency treatment for this is compression dressing to force these components back into the blood stream. Other treatments for hemangiomas have included surgical excision (of the hemangioma or residual damaged skin), laser, steroid injections & interferon injections. Recently early excision has been popularized but this is not always the best route for the reasons given above.