Hemangioma

Definition: A hemangioma is a benign proliferative blood vessel neoplasm. Hemangiomas can arise early or later in life, and there are several hemangiomas. The most common type is a cherry angioma. Congenital hemangiomas are present at birth while infantile hemangiomas appear later within the first few weeks of life.

Etiology: Hemangiomas are caused by endothelial cell proliferation. Studies suggest this may occur in three ways: increased GLUT- 1 and VEGF expression, stem cells originating from trophoblasts or de novo formation.

Epidemiology: Hemangiomas are the most common benign tumours of infancy, affecting approximately 4-5% of newborns. Infantile hemangiomas appear more frequently in Caucasian infants. Premature infants, infants with elder mothers and low birth weight infants are also more susceptible to developing hemangiomas. Most cases of hemangiomas are sporadic but are associated with an autosomal dominant inheritance pattern with no specific gene implicated.

Signs: Cherry hemangiomas typically appear as multiple firm erythematous or violaceous papules less than 1 cm in diameter. They can be scattered across any body surface If thrombosed, they can appear darker in colour before close dermatoscopic inspection when the red or purple colour is more easily seen. Infantile hemangiomas are usually solitary and appear on the head and neck. Clinical features are determined by the lesion’s depth, distribution pattern (usually facial in 77% of cases) and growth phases.

Symptoms: Cherry angiomas may be asymptomatic. Superficial, deep and mixed infantile hemangiomas are usually non-tender.

Differentials: Port-wine stain, Congenital hemangioma, Angiokeratoma, Pyogenic granuloma, Kaposiform hemangioendothelioma

Diagnosis: Hemangiomas are diagnosed clinically. A skin biopsy may also be performed. Infantile hemangiomas are positive for GLUT-1 staining. Ultrasound, CT and MRI may be performed to determine the depth of infantile hemangiomas where there are no superficial skin changes.

Treatment: Cherry angiomas are typically harmless and are left untreated. In some cases, they must be excised to rule out nodular melanoma.  Infantile hemangiomas may resolve on their own. Complicated infantile hemangiomas may require treatment. This is in the form of beta-blockers, oral prednisone, and topical corticosteroids.

References:

1. Infantile haemangioma: Definition and pathogenesis | DermNet NZ. dermnetnz.org. https://dermnetnz.org/topics/infantile-haemangioma-definition-and-pathogenesis
2. Chamli A, Aggarwal P, Jamil RT, Litaiem N. Hemangioma. In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 12, 2023.
3. ‌Angiomas. Spider naevus | DermNet NZ. dermnetnz.org. https://dermnetnz.org/topics/cherry-angioma
4. Dicko A, Safi T, Tounkara TM, et al. Prevalence des hemangiomes infantiles sur peau noire au Mali [Prevalence of infantile haemangiomas on black skin]. Mali Med. 2017;32(4):18-20.