Principles of treatment of hemangiomas

Abstract

Congenital vascular tumors have a wide variety of origins. The most common congenital vascular tumor is the GLUT-1-positive infantile hemangioma. This has to be differentiated from the congenital hemangioendothelioma and is not part of the infantile hemangiomas and is GLUT-1-negative. Both have to be differentiated from arterial, venous, lymphatic, and combined vascular malformations, including glomangiomas and systemic congenital glomangiomatosis such as hamartomatous abnormalities. They show no spontaneous regression but rather steady growth, with the exception of the abortive forms of port-wine stains (PWS) such as Unna's nevi, certain forms of cutis marmorata telangiectatica, and isolated monocytic lymphangiomas of the neck, such as hygroma colli.While the majority of infantile hemangiomas have a high rate of spontaneous regression, severe complications are possible, and it is important to identify the dangerous forms as early as possible and start early treatment to prevent secondary complications. Treatments have included laser therapy, radiation therapy, electrosurgery, cryosurgery, surgical excision, sclerotherapy, embolization, and drug therapy. The aim of therapy in cases of infantile hemangiomas as a rule is not the immediate removal, but stopping the proliferation of hemangiomas, speeding up regression of large hemangiomas, and avoidance or removal of functional problems (eye). So for focal iH a local therapy is required, while for infiltrating ("segmental") or complicated iH, adjuvant systemic therapy is necessary for downgrading.