Common Questions about Hemangiomas

A hemangioma, a type of birthmark, is a benign (noncancerous) skin tumor. It may be called a port wine stain, strawberry hemangioma or salmon patch. Typically, they are not present at birth.

Hemangiomas most often appear on the head or neck. Most will continue to grow for the first six to 12 months of life before beginning to shrink. A couple of weeks or months after birth, a small colored spot develops that can look like a red or blue freckle or bug bite. The spot will grow over many months, and will then stabilize.

The most common hemangiomas are bright red raised patches called superficial hemangiomas. Less common, deep hemangiomas appear blue-colored or like a bruise that does not go away.

Over a period of five to seven years, a hemangioma will usually diminish in size. This is called the period of involution. Sometimes they completely disappear. Larger ones may be replaced with fatty tissue and can leave the skin looking stretched out.

No. Hemangiomas are the most common vascular mass in babies. Other problems, typically referred to as vascular malformations, differ from hemangiomas. Your doctor will need to determine what kind of vascular lesion your child has to ensure proper treatment.

No. Until recently, over 90 percent of all children with hemangiomas received no treatment. In many cases, the hemangiomas fade or go away completely. Babies with hemangiomas affecting their breathing, vision, feeding, hearing or movement typically receive therapy ranging from steroids, laser treatment in an operating room, or surgical removal of the mass.

Some babies with hemangiomas were given a medicine called propranolol to treat unrelated heart conditions. Parents and doctors were surprised to find the hemangiomas shrinking, with visible results sometimes within days. Since then, doctors around the world have used propranolol in children with normal hearts for hemangioma, often with very good results. The FDA approved propanolol hydrochloride for hemangioma treatment in 2014.

A pediatric cardiologist at Vanderbilt will administer the propranolol dose, according to the baby’s weight. The doctor will also perform a complete history and physical exam and other testing before prescribing the medicine. There are some known side effects, such as lowered blood glucose, lowered heart rate, lowered blood pressure and worsening asthma symptoms. Dosing is recommended during feeding. Most babies tolerate the medicine extremely well, without side effects.

If your child has a hemangioma that is growing or stable, and it is impacting regular body function or is in a cosmetically sensitive area, this therapy can be very reasonable. The final result may depend on the individual child. Sometimes there can be residual bulkiness of the area of the hemangioma. Other times there can be some persistent skin changes (e.g. telangiectasias, or little vessels) that may not completely disappear. Unfortunately, propranolol has not been found effective in treating any other type of vascular lesion.

Typically, propranolol is continued for as long as the hemangioma is in its growth period. Once it has disappeared and tapering the medicine does not result in the hemangioma's return, propanolol is no longer needed. It is common to require a dose adjustment every couple of months before the infant is one year old as weight increases.

Alternate therapies may be offered, such as steroids, laser to the skin or within the hemangioma, or surgical removal. Every child is different. We will recommend customized treatment for your child based on many considerations.

Many infants with hemangioma do not need to see a specialist if the hemangioma is small or not of cosmetic or functional concern. If there is any impairment of functions – such as vision, breathing, feeding, or movement – or if there is ulceration and bleeding of the hemangioma, we will recommend evaluation by a specialist. Doctors seeing your child may include a pediatric dermatologist; pediatric ear, nose and throat surgeon (otolaryngologist) or pediatric plastic surgeon.