Vascular Malformations and Hemangiomas
What is a hemangioma?
A hemangioma is a type of birthmark. It is the most
common benign (non-cancerous) 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.
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 malformations,
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.
Hemangiomas are present in up to 12 percent of babies
in the first year of life. Overall, females are more
often affected than males.
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. 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 upon their size,
location, and severity. Treatment is usually not recommended
for small, non-invasive 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 upon
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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