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Kessler88 05-25-2012 06:01 AM

First-time derm visit for an H: What questions should we ask?
I am a new, first-time father and a new poster here with a question. My two-month old son was born about six weeks premature. He spent about ten days in the NICU (Jaundice) and came home from the hospital with an H about the size of a quarter on his left foot and another one about the size of a pumpkin seed on his back. I am pretty sure they emerged after birth. They emerged and grew quickly; however, since they are in rarely-seen areas, they are of little concern.

But over the past month or so, we’ve watched another one slowly emerge on his forehead. This one is considerably smaller. Currently, it’s about the size of a very small pea, but, as these things go, I expect it to get larger in time. Our GP kind of pooh-poohs it as nothing to be concerned about – that it will enlarger and go away in due course – and my wife tends to agree. It is not something that could inhibit vision or any function as far as I can tell. As a fellow who labored under teenage years with moderate acne I am sensitive to the aesthetic concerns such mark could pose were it to grow much larger and/or not recede fully, so at my urging we finally got a referral to see a dermatologist. We have an appointment with one next week. I do not believe the doctor is a pediatric dermatologist. In any case, I am writing to ask the collective wisdom of the board to know: What questions should I ask the dermatologist? What treatment options should I ask about?

What I am really wondering is really unknowable at this point. From what I have learned, I believe time may be of the essence and that early treatment might be good in this case to prevent this from enlarging, but would this be the best course? How would one know? It does seem to be enlarging very slowly. It has been emerging for more than a month now and is still quite small.

Thanks for any guidance you can give.

missy 05-25-2012 01:10 PM

Hi and welcome!

Can you post a photo, by chance? If it is an infantile hemangioma, and is not large, then wait and see might be an appropriate treatment. I would concentrate my questions on what to do IF it grows, IF it ulcerates, IF it begins to grow quickly. Ask him what the signs of involution are, so you can recognize it if need be. I would focus more on what to do if it suddenly becomes more of a problem.

Others will chime in soon, but come back next week and let us know what happens!


smurph 05-26-2012 03:42 AM

Hi there! I agree with Missy...if it doesn't seem to be growing too quickly at this point, maybe it will be ok without treatment. Sometimes I think it depends on the location too. Every hemangioma is different. I have twins that were born 5 weeks early. One had a hemangioma that grew pretty large and bright red all over her hand and wrist and it faded on its own by about 1 year old-18 months to the point you could barely see it. Her twin sister has a small one (probably about the size you described on your son)'s on the back of her has faded a lot more slowly. You can still see it and she is almost 3 1/2. It is going away but it is taking much longer. I wonder why? So I guess my point is, it is hard to predict. But if it doesn't grow really large or ulcerate I bet the chances of it going away on its own seem pretty good.

So at the dermatologist visit, I might ask how often the doctor deals with hemangiomas just to get a feeling of whether or not they have a lot of experience with them. I think this is the difference between getting "textbook" type answers and answers based on real experience in dealing with hemangiomas/treating them on a very regular basis.

I would ask if they would recommend early treatment? Why or why not?
I would also ask if they would expect it to grow quickly or leave any scarring or fatty tissue in the end after it involutes? (since it is on his forehead)
Finally, I would mention the fact that he has 3 hemangiomas and have all of them looked at. I have read that sometimes when children have multiple hemangiomas that sometimes they like to make sure there are no internal ones...although that might not be necessary for your son. But nevertheless, it wouldn't hurt to have them check out all three.

If the doctor does in fact say the recommendation is to let it run its course, let me know if you would like to see the photos of my daughter's hand hemangioma. I am still amazed that hers went away on its own. I wouldn't have thought it was possible! But it might make you feel better if you go with the wait it out option. As a side note, I am not "anti-treatment" at all, in fact my 7 year old daughter also has a hemangioma on her lip and she has taken medication, had surgery and laser. So I have been down both roads.

Keep us posted on the what the dermatologist says. I'd love to see a picture if you would like to post one. You also have the option of emailing one of the expects on this site (go to Ask the Expert) and then you can see if they agree with what your dermatologist says at your appointment.

Good luck!! Keep us posted! :)


Kessler88 05-26-2012 06:15 PM

1 Attachment(s)
Thanks for the replies. Your responses are very helpful -- things I'd not thought to ask.

I'm mildly concerned about the fact that there are three of them, which may indicate internal ones as well. I do want to bring that up during the consult. I do expect the doctor to look at all of them since each of them is slightly different. One is solid and medium-sized, another patchy and medium-sized, the third is solid and small.

Also, I'm posting a picture of the H in question.

smurph 05-27-2012 04:07 AM

I didn't want to alarm you about the possibility of internal's probably very, very unlikely. I just thought I would mention what I had read in case you wanted to ask about it as a question at your appointment. Thanks for posting the picture. Judging from the size of it and what you said about it growing very slowly, I'm guessing they might just watch it for a while, but I could be wrong. By the way, he is so cute! :) Keep us posted!


nickbar 05-30-2012 03:30 PM

If you would like to email me, I can send you a document with common questions to ask.

Kessler88 06-12-2012 06:22 PM

Post-Derm Visit Update
As expected, the recommendation on all three Hs was to wait and see before providing any kind of treatment. In all likelihood (and with some luck), they will all go away on their own.

Not surprisingly, we got a text-book definition and description of Hemangiomas, despite the fact that the derm sees them "all the time;" clearly, they are not a specialty of this doctor's practice. From what I've gathered on this board, this is typical.

Happily, the H about which we are most concerned -- the small one on his forehead -- has increased in size but very slightly and very slowly. We're keeping our fingers crossed that it will not develop much further.

Thanks for all the advice and support.

nickbar 08-01-2012 09:23 PM

You did get the typical response...but doesn't mean it isn't valid. Keep taking photos and if at any point you feel things are not going the right direction, get another opinion. You are the advocate for your baby, so don't feel pressured to do (not do) anything that doesn't fit your instincts.

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