HEMANGIOMAS James Hansen Definition of a Hemangioma A benign skin lesion consisting of dense, usually elevated masses of dilated blood vessels. Blood Vessel Formation Blood vessels are tubes of endothelial cells surrounded by layers of smooth muscle cells and connective tissue proteins, which develop as a result of biochemical signals between the two. Sometimes this communication fails and abnormal blood vessels form. Probing Vascular Disorders By analyzing gene mutations causing vascular abnormalities, much can be learned about the signals that are necessary to form normal blood vessel development. Many studies are examining the causes of hemangiomas in children and the mechanisms underlying their growth. Types of Hemangiomas Strawberry Hemangioma Cavernous (Deep) Hemangioma Compound Hemangioma Strawberry Hemangioma strawberry red mark found on 1 out of 10 babies small as a freckle or large as a coaster consists of small closely packed blood vessels 95% disappear by the time the child is 10 years old Cavernous (Deep) Hemangioma deeply situated red-blue spongy mass of tissue filled with blood found on 2 out of 100 babies grows rapidly in the first six months composed of larger, more mature vascular elements some of these lesions disappear on their own Compound Hemangioma contains both superficial and deep parts these are often the largest and the most spreading similar characteristics to both the strawberry hemangioma and the cavernous hemangioma Consider Treatment Treatment should be considered if the hemangioma…. ulcerates bleeds causes functional impairment causes infection grows rapidly and uncontrollably causes psychological problems Treatments of Hemangiomas Medical Surgical steroid injection resection interferon alfa-2a FPDL YAG laser Medical Treatments Steroid Injection benefit in managing rapid growth or functionally disabling hemangiomas prednisone or prednisolone administered with a dose of 2 to 4 mg per kg per day for two to three weeks positive response to steroids is characterized by tactile softening, lightening color or slowed growth occurring within 7 to 10 days of initial dosage if no response is seen then the treatment should be discontinued side effects include cushingoid symptoms, growth retardation and infection Medical Treatments Interferon Alfa-2a benefit in inhibiting angiogenisis and stimulate endothelial cell prostacyclin formation, which prevents platelet trapping interferon alfa-2a is administered in daily subcutaneous injections of 1 to 3 million units per square meter of body surface area for an average of 7 months of therapy 18 of 20 infants whose lesions were resistant to steroid therapy responded to interferon alfa-2a with a 50% regression rate acute side effects, which are reversible, include fever, chills, arthralgias and retinal vasculopathy Surgical Procedures Resection surgical excision is occasionally advocated as the primary treatment of hemangiomas resection surgically removes all or part of the tissue indicated as the management of visceral lesions unresponsive to steroids used for the cosmetic revision of redundant skin remaining after spontaneous involution of deeper hemangiomas Surgical Procedures FPDL - flashlight-pumped pulsed dye laser treatment of choice for superficial strawberry hemangiomas with a response rate of 60 percent penetrates to a depth of 1.8mm and has a low risk of scarring local anesthetic is effective in reducing pain or discomfort and some bruising may occur several laser sessions may be needed to achieve optimal improvement Surgical Procedures YAG Laser treatment of choice for rapidly growing deep or mixed hemangiomas with a response rate of 75 percent penetrates to a depth of 5 to 6 mm, although scar formation is more frequent than with the FPDL since the laser penetrates deeper into the skin requires local or general anesthesia not recommended in the initial treatment of cutaneous hemangiomas Conclusion hemangiomas may be unpredictable - they may proliferate, remain constant or involute treat when vital anatomic areas are involved or growth is rapid treat if bleeding, ulceration or infection occurs make use of all modalities as needed References Eisenberg, Arlene & Hathaway, B.S.N., Sandee E. & Murkoff, Heidi E. 1989. What To Expect The First Year. New York: Workman Publishing Company Lehrer, M.D., Michael. 10/28/2001. Birthmarks-Red. April 11, 2003, http://www.pennhealth.com/ency/article/001440.html Lowitt, M.D., Mark H. & Wirth, M.D. Fern A. 2/15/1998. Diagnosis and Treatment of Cutaneous Vascular Lesions April 11, 2003, http://www.aafp.org/afp/980215ap/wirth.html Olsen, M.D., Ph.D., Bjorn R. 2000. The Forsyth Institute. April 10, 2003, http://www.forsyth.org/re/re_I_olsen.html American Osteopathic College of Dermatology. 2001. Hemangiomas. April 10, 2003, http://www.aocd.org/skin/dermatologic_disease/hemangiomas.html Dedication This presentation is dedicated to my daughter, Gabriella, who was diagnosed with a hemangioma located on her parietal lobe at birth.