What is a hemangioma?
A hemangioma is a benign vascular tumour formed by proliferation of the cells lining the inner surface of blood vessels. It is the most common tumour of infancy. It is not a cancer and does not spread to other organs.
Its distinguishing feature is its course: a hemangioma is usually absent at birth, or noticed only as a pale mark or a small patch of redness. It becomes apparent in the first weeks, grows for a period, and then begins to regress on its own. This behaviour is what separates a hemangioma from the vascular structural anomalies that are present from birth and never regress.
Its natural course: growth, then regression
| Phase | Timing | What happens |
|---|---|---|
| Appearance | First days – first weeks | Becomes visible as a pale mark or slight redness. |
| Growth | Roughly the first 6–9 months | Growth is fastest in the early months; the lesion becomes raised and deeper in colour. |
| Plateau | Around 9–12 months | Growth stops and the size remains stable for a period. |
| Regression | After the first year, over several years | Colour fades and the lesion flattens; the process is slow and gradual. |
These intervals vary between babies. Regression does not mean the lesion will disappear without trace: loose skin, fatty tissue or fine dilated vessels may remain.
Hemangioma or vascular malformation?
These two conditions are often confused with one another. The distinction matters because it determines treatment from the outset.
| Hemangioma | Vascular malformation | |
|---|---|---|
| At birth | Usually absent or indistinct | Present (sometimes noticed later) |
| Course | Grows, then regresses | Does not regress; grows with the child |
| Nature | Cell proliferation (vascular tumour) | Structural anomaly of the vessel |
| Approach | Most are observed; medication if needed | Waiting does not resolve it; planned treatment is required |
For this reason, when the label “hemangioma” is applied to a lesion that is in fact a malformation, years can be lost in unnecessary waiting.
Which hemangiomas need close follow-up?
Most hemangiomas cause no problems. Early assessment is needed in the following situations:
- Lesions around the eye; pressure on the eyelid can affect vision and visual development.
- Lesions involving the airway; hoarseness or noisy breathing is a warning sign, particularly with lesions extending over the jaw and neck.
- Ulceration and bleeding; more frequent on the lip, the nappy area and skin creases, painful and carrying a risk of infection.
- Lesions on the nose, lip or ear; these are more likely to leave a lasting change in shape after regression.
- Multiple hemangiomas; these call for assessment for accompanying lesions in the internal organs, particularly the liver.
- Extensive segmental involvement of the face, or a lesion over the lower back and sacrum; further investigation for associated anomalies may be required.
Diagnosis
The diagnosis is usually made from examination and the history of the course; when the lesion appeared and how it has changed is the most valuable information. Photographs taken by families at regular intervals therefore contribute directly to the diagnosis.
Where required, colour Doppler ultrasound demonstrates the flow characteristics. In deep or extensive lesions, or where the diagnosis is uncertain, MRI is used to assess the margins and the surrounding structures.
Treatment
The most frequently chosen approach is planned observation. In a hemangioma that is causing no problems, the aim is to avoid unnecessary intervention and allow natural regression. Observation means examination, measurement and photographic documentation at defined intervals.
Where treatment is required, the options are:
- Medication. Beta blockers are effective in halting the growth of hemangiomas and accelerating their regression, and are today the first choice in cases that require treatment. Topical forms may be used for small, superficial lesions. Systemic use is conducted under medical supervision, with monitoring of parameters such as heart rate and blood glucose.
- Laser. Used to support healing in ulcerated lesions and to treat the fine dilated vessels that remain after regression.
- Surgery. Used to correct the excess skin and fatty tissue left after regression, for lesions that impair function, and in selected cases. Timing is planned with the child’s age and school years in mind.
The choice of method depends on the site, depth and growth rate of the lesion and on the age of the child. Using more than one method in sequence is a common situation.
What families ask most
The months in which a hemangioma is growing are the most anxious period for a family. Knowing that the rate of growth will slow of its own accord makes that period easier. At the same time, the assumption that “it will resolve by itself” is not correct for every lesion: where vision, breathing or feeding is affected, waiting means losing time.
Assessment
The right decision in a hemangioma comes from considering the site of the lesion, its course and the age of the baby together. Observation is also a treatment decision, and it needs to be reviewed at regular intervals.
If you would like an assessment for a vascular lesion in your baby, you are welcome to book an appointment; bringing photographs from earlier months will speed up the process.