Hemangiomas: Clinical picture

Abstract

Infantile hemangiomas or hemangiomas of infancy are the most common benign cutaneous tumors of infancy. The pathogenesis of infantile hemangiomas remains unclear. They are composed by masses of capillaries lined by endothelial cells that have a unique vascular phenotype demonstrated by the erythrocyte-type glucose transporter protein staining (GLUT-1). Infantile hemangiomas present shortly after birth most often as well-demarcated, flat, and erythematous red patches. They follow a predictable course with three distinct phases: proliferation (8-18 months), involuting phase (1-7 years), and involuted. They are classified as superficial, deep, or combined. Another subclassification of IH is focal, segmental, indeterminate, and multifocal. Multifocal can be associated with visceral involvement. Most hemangiomas are asymptomatic and can be managed with close observation. A significant minority of IH (20 %) during the rapid growth phase are associated with important complications such as ulceration, bleeding, risk for permanent disfigurement, compromised organ function (vision and airway obstruction), or high-output cardiac failure. Segmental hemangiomas are frequently associated with structural anomalies and/or visceral hemangiomas. Patients with facial segmental hemangiomas and likewise with lumbosacral segmental hemangiomas should undergo imaging studies to rule out PHACE syndrome and PELVIS/SACRAL/LUMBAR syndrome, respectively.