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Clinical Presentation
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History and Physical Examination
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Approximately 2% of live births will have a form of hemangioma. This increases to approximately 10% by 1 year of age. There is an up to 3-fold risk for female infants.9 Infantile hemangiomas are not usually present at birth, but early signs of their development such as pallor, or telangiectatic macules may be present in up to 50% of infants who go on to have an infantile hemangioma. At its peak size an infantile hemangioma typically presents as nodule which typically is 1 to 8 cm, but may range from pinpoint size to greater than 25 cm in diameter (Figure 16-16). The natural history for infantile hemangiomas is a period of growth followed by a drawn out involution phase. The growth phase is usually complete by 1 year of age. The involution phase is variable and can last between 2 and 10 years or greater. As the tumor resolves it develops a white-grey area and may ulcerate.
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An infantile hemangioma is a vascular tumor, as it demonstrates cellular hyperplasia. While biopsy is not indicated, these lesions can be differentiated from congenital hemangiomas by positive staining for transporter-1 (GLUT-1). Histopathology shows proliferation of endothelial cells in the dermis and/or subcutaneous region.
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Differential Diagnosis
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In the past, patient observation was the rule. However, particular attention needs to be paid to lesions involving cosmetically sensitive areas or areas that my cause disruption of normal development or anatomy. These sites include the nasal tip, periorbital region, ears, lips, genitalia, airway, or beard distribution.10 Also treatment is recommended for ulcerating lesions. Historically, treatment when indicated was limited to topical or oral steroids with the adjuvant use of pulsed dye laser (PDL) therapy.11 Recently it has been discovered that these lesions respond remarkably well to oral administration of propranolol.12 This should only be attempted by a very experienced clinician in a controlled setting as this treatment can lead to hypoglycemia13 and bradycardia. PDL therapy is still indicated in ulcerative lesions or thin cosmetic lesions.
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Indications for Consultation
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Lesions in cosmetic or structurally sensitive areas of the nasal tip, lips, visual field, or beard region. Lesions in the groin have a higher incidence of ulceration and pain that warrants referral.
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Vascular Birthmarks Foundation: www.birthmark.org/node/24