Hemangiomas are benign neoplasms of vascular origin.
Two major categories are distinguished:
- in the first category are the congenital hemangiomas (they are present at birth) and neonatal hemangiomas (occurring shortly after birth).
- in the second category are the acquired hemangiomas that occur sometime from adulthood onwards.
Congenital & Neonatal Hemangiomas
These are benign neoplasms of the vascular tissue, which are present at birth or appear in the first year of life and are red, violet or cyan.
Most lesions follow a predictable, benign clinical course. Initially, they grow rapidly for several weeks, then stay stable for several months and finally over the years they resolve, often resulting in an area of fibrosis, atrophic scarring, depigmentation or excess skin. Approximately 50% of lesions resolve before the age of 5 years and 70% before the age of 7 years.
Lesions that do not show signs of involution until the age of 6 years usually do not resolve completely. The overlying epidermis of the hemangiomas can be ulcerated resulting in bleeding.
Depending on their location, in the fast-growing phase, can exert pressure on vital anatomical structures (eyelids, external acoustic duct, and airway), causing amblyopia, strabismus, disorder of normal speech development, feeding problems and airway problems. In these cases, they should be urgently treated surgically.
Lesions that have a rapid growth rate in the proliferation phase, can be treated with β-adrenergic inhibitors, corticosteroids, interferon-α and laser. On the contrary, hemangiomas that follow a benign course and do not threaten vital structures are kept to resolve on their own. Parents’ complacency, patience and regular monitoring are required.
Some degree of atrophy and scarring is usually observed in the skin or a small residual lesion remains, in the end of the clinical course of hemangiomas. The treatment of these conditions is done by surgical removal, for aesthetic reasons.
Acquired hemangiomas or cherry angiomas are benign neoplasms of vascular origin, which are found in almost all individuals over 30 years of age.
These appear early in the adult’s life. The lesions gradually increase in size and number with age, do not cause general symptoms and persist for an indefinite period.
The color of the lesions changes from the red color of the cherry, hence their name, to a deeper brown color as their size grows.
When injured, bleeding occurs, which is easily controlled by pressure on the lesion.
Acquired lesions are randomly distributed to the body. The lesions are more in the trunk and less in the head, the neck and the extremities.
Their number ranges from a few to hundreds of them. In the case of progressive development of a large number of hemangiomas we should not worry. However, the sudden appearance of numerous lesions, like rash, should be investigated.
The treatment of acquired hemangiomas is usually done for aesthetic reasons but also for therapeutic purposes when they are injured and bleeding. In the case of minor lesions the CO2 laser is used. In cases of larger lesions as well as for those found in specific positions (nose, eyelids, lips, ear, scalp), surgical removal and histological examination is considered to be the treatment of choice and has an excellent aesthetic result.