Recent Trends in Management of Infantile Hemangioma

Abstract

Hemangiomas of infancy (HOI) are the most common benign tumors in children. The incidence in the general newborn population is between 1.1% and 2.6%, but increases to up to 12% by one year of age. Infantile hemangiomas (IH) have to be classified according to stage, growth pattern, appearance and organ specificity. Infantile hemangiomas can present as superficial (bright red plaques), deep (blue subcutaneous nodules), or mixed (both components) type. Visceral haemangiomas may be located in Brain, Thyroid, parotid, mediastinum, lung, pleura, heart, esophagus, Thymus, stomach, intestine, liver, spleen, pancreas, urinary tract, penis, testicle, female genital tract, breast, face and anogenital haemangiomas. The most common site of internal organ involvement is the liver, followed by the gastrointestinal tract, the brain, the mediastinum and the lung. Diagnosis of hemangiomas is based first on the patient’s medical history and physical examination. After physical examination hemangiomas should be classified as superficial, deep, or mixed type, according to their location in the skin and subcutaneous tissue. Superficial infantile hemangiomas may be mistaken for capillary malformations (port-wine stains). Deep infantile hemangiomas may resemble lymphatic, venous, or mixed (venous and lymphatic) malformations In cases in which clinical examination alone is inconclusive, other diagnostic modalities such as ultra sonography and magnetic resonance imaging (MRI) may be utilized Doppler ultrasound can assess the flow of a hemangioma, characterized by a shunt pattern with decreased arterial resistance and increased venous velocity, but the most important tool is contrast enhanced magnetic resonance imaging (MRI). The most common treatments are drug therapy, laser treatment, and surgical excision. Treatments such as X-ray and sclerotherapy are no longer indicated, and cryotherapy has been replaced by laser, while embolization is only indicated as a final treatment option. We would like to point out that hemangiomas generally do not require treatment unless the tumor interferes with normal functions such as vision, breathing, eating, voiding or stooling. Other indications for therapy include the risk of serious disfigurement unlikely to resolve by itself or giving rise to ulceration, bleeding, infection, pain or heart and liver failure Medical treatment for hemangiomas includes Oral Beta-Blockers like Propranolol , Acebutolol and atenolol, Corticosteroids, Vincristine, Interferon, Cyclophosphamide, Rapamycin, and New Anti-Angiogenic Drugs. Surgical management of infantile hemangiomas (Hm) usually consists of late correction of contour deformities after completed spontaneous involution with excision of remaining fibrofatty tissue and exuberant skin. Indications to surgery are normally restricted to the treatment of fibro-fatty remnants with different techniques: excision of exuberant fibro-fatty tissue (liposuction can be employed) and correction of contour deformities.