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Hemangiomas are the most common type of birthmark or benign tumor of the skin. They are either present at birth or appear shortly after birth and grow rapidly. Most develop on the skin in the head or neck area. There are three types of hemangiomas: infantile hemangioma, non-involuting congenital hemangioma (NICH) and rapidly involuting congenital hemangioma (RICH).
Infantile hemangiomas are benign growths of blood vessels. The lesions may not be present at birth but usually develop within the first three months of life. They occur most commonly in the head and neck region but can be present anywhere on the body. Hemangiomas may occur in infants of all races; they occur more frequently in females than males. Premature birth, low birth weight and mothers with multiple prior pregnancies are some of the factors that have been associated with the formation of infantile hemangiomas.
Signs & Symptoms
These birthmarks first appear as scratch-like or bruise-like marks or bumps and gradually grow in size over the first year of life. They have been referred to as “strawberries” because the bumps on the skin are often bright red.
Infantile hemangiomas follow a specific pattern of growth and involution (shrinking and lightening in color). The emerging stage usually occurs from birth to three months of age, followed by an early and late growth stage, typically from six to 10 months. During the growth phases, the lesions initially expand rapidly and then stabilize. Infantile hemangiomas usually reach the maximum size by five or six months of age. After the first year of life, they slowly shrink and lighten in color, a process called involution. The involution stage may be most rapid between infancy and 4 years of age, but can also progress more gradually over the subsequent five to 10 years of the child’s life.
Most infantile hemangiomas can be diagnosed by a physical exam. Other diagnostic tools — such as blood tests, biopsy, ultrasound, magnetic resonance imaging and angiogram — may be necessary in certain circumstances. Our vascular anomalies team will determine the necessary tests needed for a comprehensive evaluation.
Treatment is usually not required because infantile hemangiomas become smaller on their own. Medical or surgical intervention may be necessary if the hemangioma causes complications such as bleeding, interference with breathing, feeding or vision, or other life threatening events.
Non-involuting congenital hemangiomas (NICH) are benign growths of blood vessels. These lesions are fully developed at birth and do not involute (shrink and lighten). This type of hemangioma frequently occurs on the head, neck, lower jaw and joints. It occurs equally in males and females.
Signs & Symptoms
A non-involuting congenital hemangioma grows at a rate proportional to the child’s growth. The lesions are typically roundish bumps with a blue-red, pink or purple color, and have a surrounding pale halo. The surface of the bump may be covered with dilated blood vessels called telangiectasias.
Most NICHs can be diagnosed by a physical exam. Other diagnostic tools may be required, such as blood tests, biopsy, ultrasound, magnetic resonance imaging and angiogram. Our vascular anomalies team will determine the necessary tests needed for a comprehensive evaluation.
Symptoms and complications related to NICH are rare. However, if the non-involuting congenital hemangioma is troublesome, surgical removal may be necessary.
Rapidly involuting congenital hemangiomas (RICH) are benign growths of blood vessels. They are fully developed at birth and do not grow. This type of hemangioma typically involutes (shrinks and lightens) over the first two years of life. RICH are usually located on the head and neck and near joints, and occur equally in males and females.
Signs & Symptoms
Rapidly involuting congenital hemangiomas lesions can vary in appearance depending on the stage of the lesion. Initially, RICH are raised round bumps with a pale halo. Some of the bumps can be dark purple in color and have dilated blood vessels called telangiectases on the surface. When the lesion begins to involute, the bump shrinks in size and the telangiectases lighten in color.
Using prenatal ultrasonography (sonograms), rapidly involuting congenital hemangiomas can be diagnosed in a fetus as early as 19 weeks of pregnancy.
Most RICHs also can be diagnosed by a physical exam. Other diagnostic tools may be required such as blood tests, biopsy, ultrasound, magnetic resonance imaging and angiogram. The vascular anomalies team will determine the necessary tests needed for a comprehensive evaluation.
Treatment is rarely required since this type of hemangioma shrinks in size after birth. However, if the RICH remains unchanged in size and causes complications — such as ulceration, bleeding or functional compromise — then surgical removal may be necessary. In some cases, a rapidly involuting congenital hemangioma leaves behind excess skin and dilated veins. In these instances, surgery may be recommended for reconstructive purposes.
The vascular anomalies program at Comer Children's offers an integrated and comprehensive approach to the diagnosis, care and management of vascular malformations. Our multidisciplinary team of pediatrics experts works together to educate families and to evaluate and treat children with all types of these vascular lesions.