Hemangioma natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Natural history

• In brief, hemangiomas are vascular tumors that are rarely apparent at birth, grow rapidly during the first six months of life, involute with time and do not necessarily infiltrate but can sometimes be destructive.

• Hemangiomas go through three stages of development and decay:

1. In the proliferation stage, a hemangioma grows very quickly. This stage can last up to twelve months.
2. In the rest stage, there is very little change in a hemangioma's appearance. This usually lasts until the infant is one to two years old.
3. In the involution phase, a hemangioma finally begins to diminish in size. Fifty percent of lesions will have disappeared by age five with the vast majority gone by puberty.

Complications

The vast majority of hemangiomas are not associated with complications. Hemangiomas may break down on the surface to form ulcers. If the ulceration is deep, significant bleeding may rarely occur. Ulceration on the diaper area can be painful and problematic.

If an hemangioma develops in the larynx, breathing can be compromised. A hemangioma can grow and block one of the eyes, causing an occlusion amblyopia. Very rarely, extremely large hemangiomas can cause high-output heart failure due to the amount of blood that must be pumped to excess blood vessels. Lesions adjacent to bone can also cause erosion of the bone.

The most frequent complaints about hemangiomas, however, stem from psychosocial complications: the condition can affect a person's appearance and can provoke attention and malicious reactions from others. Particular problems occur if the lip or nose is involved, as distortion can be difficult to treat surgically.