Last updated: 02/17/2009

Hemangiomas undergo a characteristic set of stages during the tumor development. Approximately 30% are present at birth, with the remainder appearing within the first few weeks of life, often beginning as a well-demarcated pale spot that becomes more...

noticeable when the child cries. The tumors are highly variable in presentation and range from flat, reddish areas known as superficial hemangiomas, to those that are bluish in color and located further under the skin, and are known as deep hemangiomas.

During the first six to 18 months of life, hemangiomas undergo a stage where they grow at an excessive rate in size due to abnormal cell division. The final size of the tumors can range from tiny, hardly noticeable red areas to large, disfiguring growths. In almost all hemangiomas, a long, slow involution process that follows the proliferation stage can take years to complete. Among the first signs of the involution process is a deepening of the red color of the tumor, a graying of the surface, and the appearance of white spots. In general, 50% of all hemangiomas are completely involuted by age five, and 75–90% have completed the process by age seven.

Once a decision to treat a hemangionma with surgery is made, the exact technique to be utilized must also be determined. The most commonly used technique for small lesions is very straightforward and involves removing the abnormal vascular tissue with a lenticular, or lens-shaped excision, that results in a linear scar. Recently, some surgeons have been advocating the use of an elliptical, circular, or irregular incision shapes, followed by a purse-string-type closure. This technique does result in a scar having radial (starshaped) ridges that can take several weeks to flatten. However, the overall result is a shorter scar that can be followed up by removal, using the lenticular excision technique.

Larger, more extensive lesions may require angiography, a process that maps the path of the vessels feeding the lesion, and embolization, the deliberate blocking of these blood vessels using small particles of inert material. This process is followed by complete removal of the abnormal tissue.

Depending on the size and nature of the tumor, the excision surgery can be done on an outpatient or inpatient basis. For very small lesions, local anesthetic may be sufficient, but for the great majority, general anesthesia is necessary to keep the patient comfortable.