Hemangioma

A hemangioma (pronounced he-man-jee-O-muh) is a type of raised birthmark. The bright red growth, which is sometimes called a strawberry mark, is a collection of extra blood vessels that usually appears on the skin of the face or neck or on organs such as the liver. Hemangiomas are benign, or noncancerous, and usually do not present any serious health complications. Most hemangiomas appear at birth, grow larger as the person ages, and disappear by the time that person reaches ten years old. No ways exist to prevent hemangiomas, and no exact cause of them has been found. They are typically not a severe medical issue, depending on the location they are found. Ones that cause secondary medical concerns may need to be removed surgically.

Background

Most hemangiomas are congenial, or present at birth, but some can appear in the first few months of a baby's life. Two types exist: cutaneous hemangiomas and extracutaneous hemangiomas. Cutaneous hemangiomas, also known as capillary hemangiomas, appear on the top layers of the skin. They usually start out as a flat red mark on the back, chest, face, or scalp. More than 60 percent of hemangiomas appear on the head or neck. The mark then grows quickly into a red nodule that is raised from the skin. After a period of accelerated growth, the hemangioma typically becomes dormant and begins to disappear. Many fade away by the age of five, and most are completely gone by the time a person turns ten. However, a faint permanent mark on the skin or a skin tag (raised piece of skin) may remain after the hemangioma disappears. Large nodules may leave behind stretch marks or sagging skin where they were located. If the hemangioma is located in a place that will make vision, hearing, or breathing difficult, it may need to be removed through surgery. It will also need to be removed if it is located on the outer genitals or anus and interferes with urination or elimination.

Extracutaneous hemangiomas, also known as cavernous hemangioma, can form deep in the skin and on organs. Some of the most common sites of extracutaneous hemangiomas include the adrenal glands, bladder, central nervous system, gallbladder, gastrointestinal tract, larynx (throat/vocal cords), liver, lungs, lymph nodes, pancreas, spleen, and thymus (gland). The brain is rarely affected by hemangiomas. Most people with these types of hemangiomas do not ever know they have them; most are found during tests or procedures for other medical conditions. These typically are not serious, but like cutaneous hemangiomas, the location may be cause for concern.

Most children are born with only one hemangioma, but sometimes children who are from a multiple birth, such as twins or triplets, will have more than one. About 20 percent of children will develop more than one hemangioma. In addition, children with multiple skin hemangiomas usually have extracutaneous hemangiomas of the organs.

The causes of the birthmark are not known or understood; hemangiomas may or may not be hereditary. Some studies have linked estrogen to the development of the growths. Researchers have ruled out the link between hemangiomas and drugs or medications taken during pregnancy as well as environmental exposures. Some risk factors exist that increase the likelihood of developing hemangiomas. These include being female, premature, part of a multiple birth, or Caucasian. Children who are products of a difficult birth or one that had complications are at an increased risk of developing hemangiomas.

Overview

The word hemangioma is derived from the Greek words haema, which means "blood"; angeio, which means "vessel"; and oma, which means "tumor." A hemangioma is actually nothing more than a blood vessel tumor. They are usually very small and can range from the size of a pinhead to about twenty centimeters around. Some can be larger than this.

A doctor can diagnose a cutaneous hemangioma by sight. An extracutaneous hemangioma is more difficult to determine and may require diagnostic tests, such as x-rays, ultrasounds, computerized tomography (CT) scans, or magnetic resonance imaging (MRI). Physicians typically monitor the marks during checkups and office visits.

Hemangiomas that develop on the larynx may cause breathing issues. They can also grow on or near the eyes, blocking vision, or the ears, interfering with hearing. In addition, extracutaneous hemangiomas can cause cardiovascular issues because the heart needs to pump more blood to the blood vessels that make up the hemangioma. However, this is very rare. Some people may suffer from psychological and social issues related to appearance, especially when hemangiomas are very large and visible on the face. The hemangiomas are usually removed in these cases.

Hemangiomas also are associated with the rare conditions PHACE syndrome and Kasabach–Merritt syndrome (also called Kasabach-Merritt phenomenon). PHACE stands for a group of conditions: posterior fossa, which is a brain malformation; hemangioma; arterial lesions; cardiac abnormalities or aortic coarctation; and eye abnormalities. Kasabach-Merritt syndrome is a bleeding condition caused by a hemangioma.

Most times, hemangiomas cause no issues and go away on their own, requiring minimal treatment. Some cutaneous hemangiomas can develop sores that bleed or become infected. These may require treatment, including corticosteroid medication injections or applications of medicated gel. The hemangioma may also need to be removed surgically, by cryotherapy (freezing), or by laser. Laser treatment also is used to reduce the redness of hemangiomas.

Extracutaneous hemangiomas can cause symptoms such as pain or discomfort, weight loss, fullness, nausea, vomiting, or loss of appetite. These are usually in response to the hemangiomas enlarging or multiple hemangiomas forming. Treatment involves surgery to remove the hemangioma or part of the damaged organ, or to tie off the artery supplying blood to the hemangioma.

Bibliography

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