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]
Overview
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.[1]
- Hemangiomas follow a predictable course with three distinct developmental phases:
- Proliferation phase
- Quiescence phase
- Involution phase
Proliferation phase
- In most hemangiomas, eighty percent of proliferation occurs by three months of life but may last longer..[1]
- During proliferation, rapid growth can lead to exhaustion of blood supply with resulting ischemia, necrosis, ulceration, and bleeding.
Quiescence phase
- Following proliferation, hemangiomas enter a slower or no growth phase, known as quiescence..[1]
- This phase typically lasts from nine to twelve months of age.
Involution phase
- The final and unique phase of the hemangioma lifecycle is involution..[1]
- This phase is marked by graying of the overlying skin and shrinking of the deeper components.
- At the final stages of involution, a fibrofatty protuberance may remain.
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.