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Untreated Hemangiomas: Growth Pattern and Residual Lesions

Bauland, Constantijn G. M.D.; Lüning, Thomas H. M.D.; Smit, Jeroen M. M.D.; Zeebregts, Clark J. M.D., Ph.D.; Spauwen, Paul H. M. M.D., Ph.D.

Plastic and Reconstructive Surgery: April 2011 - Volume 127 - Issue 4 - p 1643-1648
doi: 10.1097/PRS.0b013e318208d2ac
Pediatric/Craniofacial: Original Articles

Background: Hemangiomas of infancy can give rise to alarm because of their rapid growth and occasional dramatic appearance. The objective of this study was to investigate the growth pattern of hemangiomas and risk factors for residual lesions.

Methods: A follow-up study was performed of patients with hemangiomas that were clinically monitored between 1985 and 2000 and who did not receive any treatment. The data were retrieved from medical files. Patients (parents) were asked to complete a questionnaire and invited to our outpatient clinic where the questionnaire was discussed and physical examination was performed. The growth phases of the hemangioma were documented, the timeline of these phases was constructed, and an assessment was made of the residual lesion if present.

Results: In 97 patients, 137 hemangiomas were evaluated. A precursor lesion was present in 48 percent of children. Maximum size was reached in 8 months. Involution started at a median age of 2 years and was completed at a median age of 4 years. Residual lesions were present in 69 percent of cases. Superficial nodular hemangiomas showed significantly more residual lesions (74 percent) than the deep hemangiomas (25 percent) (p < 0.001; odds ratio, 8.4; 95 percent confidence interval, 2.4 to 29.1). Untreated infection, ulceration, or bleeding produced a scar in 97 percent of the cases.

Conclusions: Epidermal invasion of the hemangioma is of predictive value for residual lesions. There is no correlation between the growth pattern of a hemangioma and the risk for a residual lesion. This may add to a more detailed prediction of outcome and may help to decide which patient should be treated or not.

Nijmegen, Eindhoven, and Groningen, The Netherlands

From the Departments of Plastic and Reconstructive Surgery of Canisius-Wilhelmina Hospital, Radboud University Nijmegen Medical Center, and Catharina Hospital Eindhoven, and the Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen.

Received for publication July 21, 2010; accepted September 28, 2010.

Disclosure:The authors have no potential or actual, personal, political, or financial interests in the, material, information, or techniques described in this article.

Constantijn G. Bauland, M.D.; Department of Plastic and Reconstructive Surgery; Canisius-Wilhelmina Hospital; P.O. Box 9015; 6500 GS Nijmegen, The Netherlands;

©2011American Society of Plastic Surgeons