General Medical Information

Hemangiomas

Wilberto Nieves-Neira
Bhagirath Majmudar
Ira R. Horowitz

Hemangiomas are the result of anomalous development of blood vessels. They are congenital malformations consisting of dilated blood vessels that may cause tumors in the dermis or subcutaneous tissues. Hemangiomas are the most common soft-tissue tumors of infancy, occurring in approximately 5% to 10% of 1-year-old children. The female-to-male ratio is 3:1. Hemangiomas may be visible at birth or become apparent in the first few weeks of life. Normally they go through a phase of growth followed by stabilization and even regression over the course of several years. In general, hemangiomas regress at the time of menarche and rarely leave any distortion of the normal architecture. A case of capillary-venous malformation worsening after puberty has been reported. Lesions vary from small hemangiomas commonly adjacent to the clitoris to large vascular dilatations that may develop in the prepuce. Ulceration is the most common complication of hemangiomas. Ulcerations may be extremely painful and are associated with secondary infection, bleeding, and scarring. This presentation of vulvar hemangiomas may be confused with sexual abuse. Expectant management should be followed in most cases. Cool sitz baths and Domeboro compresses often relieve local discomfort and edema of larger lesions. Local control measures are sufficient to stop bleeding from capillary hemangiomas. Systemic corticosteroids have become a mainstay in the treatment of hemangiomas (prednisone or prenisolone 2 to 3 mg/kg/day). Approximately one third of hemangiomas exhibit dramatic shrinkage with this therapy. Surgical excision or ablation may treat small hemangiomas that do not regress spontaneously using an argon or Nd:YAG laser. Cavernous hemangiomas are composed of larger vessels and may result in profuse bleeding if injured. Consumptive coagulopathy may occur, and radiographic embolization may be needed before definitive treatment. Unilateral varices with recurrent bleeding may require ligation of vessels in the inguinal canal as most of the blood supply to the upper external genitalia comes from the pampiniform plexus. It should be recognized that the area below the clitoris is supplied by the pudendal vessels.