One in ten children are born with a vascular birthmark, most being a hemangioma. Ninety percent (90%) will resolve on their own. The remaining 10% – roughly 40,000 babies each year – who will need the opinion of a specialist are the children that VBF is most concerned about because of the ongoing questions about if and when to pursue treatment. VBF pushes for early and appropriate treatment as soon as a hemangioma is diagnosed to prevent future complications – both physical and psychosocial.
There are often “gray area” of lesions that parents want treated but doctors do not want to treat. Again, parents have a right to have the hemangioma treated if they feel that leaving the lesion may result in physical or psychosocial issues for the child.
Be reminded that 70% of all hemangiomas left untreated will leave a redundant sagging chunk of tissue behind. If corrective surgery is deferred until after the hemangioma has completely involuted, which is around age 10, insurance will routinely deny coverage because too much time has gone by since the diagnosis.A hemangioma that is ulcerating, bleeding, potentially obstructive to vision or airway, or rapidly growing, must be treated as soon as possible.
The gold standard for treatment is an oral beta blocker; the FDA approved version is called HEMANGEOL. A topical form of beta blocker is used for flat, newly emerging lesions.
Laser is very effective with early lesions and, when combined with topical beta blockers, can knock a newly emerging hemangioma off course.
Surgery is used when the lesion does not respond to other therapies or when it is severely problematic and there is no time to wait for the hemangioma to shrink. Surgery is also used when the lesion is in a critical location, such as the nasal tip or breast bud area. A beta blocker can effectively shrink these lesions but they must be treated sooner, rather than later, to prevent underlying problems. Orbit hemangiomas must also be treated as soon as possible to prevent astigmatism.
Intralesional steroid injections or a course of oral steroid were once considered an appropriate treatment for infantile hemangiomas, but with the emergence of propranalol or Hemangeol for treatment, it is usually not recommended for patients to undergo treatment with steroids.
The old school “benign neglect” philosophy of “leave it alone, it will go away” is not acceptable unless the hemangioma is insignificant and has no potential for being problematic. Thankfully, a huge percentage of hemangiomas are very small, hidden in hair or obscure locations, and need no treatment.
For more information, watch the 60-minute discussion in this Facebook Live video replay in which Dr. Linda discusses the need for early intervention of all types of vascular anomalies.