Vascular malformations and hemangiomas are commonly known as “birthmarks.” They can be present at birth or appear in the first months of life. Early diagnosis and treatment is important for the child’s health and appearance. Each year the Craniofacial Team at Children’s National Hospital diagnoses and treats many children with 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. It may be present at birth as a faint red mark, or appear in the first months of life. Hemangiomas can be:
- Capillary – forming on the skin’s top layer
- Cavernous – embedded in the skin’s deep layers
Hemangiomas have three stages:
- Proliferation – grows from a faint red mark to full size
- Resting – no change
- Involution – mark slowly disappears
The whole process can take up to several years.
What is a vascular malformation?
A vascular malformation is a type of birthmark always present at birth which grows proportionately with the child. It does not involute (disappear), but may worsen or become more apparent as the child grows.
There are different types of vascular malformations, named according to the type of blood vessel that is most affected. Arteries, veins, capillaries, and/or lymphatic vessels may be involved. Other names for vascular malformations include lymphangiomas, arteriovenous malformations or vascular gigantism.
What causes hemangiomas and vascular malformations?
Hemangiomas and vascular malformations usually occur sporadically (by chance). However, they can be inherited by way of an autosomal trait, meaning that if one parent carries the gene necessary to express the condition, there is a 50 percent chance the child will receive the gene.
Up to 12 percent of babies develop hemangiomas in the first year of life, and females are affected more often than males.
How are hemangiomas and vascular malformations diagnosed?
A physician is able to diagnose hemangiomas and vascular malformations after a physical examination. Sometimes a CT scan (link to glossary) or an MRI (link to glossary) is performed to determine the severity of the formations, and to what extent various structures are affected by them.
In some cases, hemangiomas and vascular malformations can be particularly large, severe or poorly located. They may possibly affect organ systems or impede vision development. In extreme cases, they can be life-threatening: a hemangioma could ulcerate and bleed uncontrollably, or a vascular malformation could affect the respiratory system.
Large, potentially life-threatening formations should be evaluated by a multidisciplinary team – plastic surgeons, dermatologists, ophthalmologists, radiologists and possibly other specialists, depending on the organ involved – and should be treated as soon as possible.
What does treatment for hemangiomas include?
For capillary hemangiomas, which form on the skin’s top layer and tend to disappear without any permanent skin distortion, doctors often opt out of any treatment regimens. In some cases, they may use laser treatment to eradicate any remaining blood vessels.
Cavernous hemangiomas often demand treatment, as they can leave permanent marks on the skin or impede normal development or organ function. The most common treatments are:
- Steroids – injected or administered orally
- Laser therapy – selectively damages blood vessels but not the skin
Often the two treatments are used together and can rapidly accelerate healing.
What does treatment for vascular malformations include?
Treatment for vascular malformations varies depending on the type.
For capillary malformations or “port wine stains” – flat, violet, or red patches on the face – laser therapy is effective.
Arterial malformations may be treated with embolization (link to glossary), the injection of material near a lesion to block blood flow to it.
Venous malformations may be treated by injecting a clotting medication.
Very often, physicians use a combination of treatments.