We have read the article published by Goldenberg et al. entitled “Surgical Treatment of Facial Infantile Hemangiomas: An Analysis Based on Tumor Characteristics and Outcomes”1 with great interest. It is focused on surgical treatment of infantile hemangiomas of the face, and provides interesting indications on surgical management.
We believe that aesthetic considerations after removing a tumor from an infant’s face constitute an important issue. However, in our opinion, the most important issue is establishing the correct diagnosis preoperatively. Vascular dysplasias or tumors are sometimes misdiagnosed as hemangiomas and sometimes treated surgically as such.2,3 Correct diagnosis can lead to preoperative beta-blocker administration and tumor size reduction in cases of hemangiomas. When tumor size is reduced, residual postoperative scar is also reduced. In our experience, we prefer, like other authors, to obtain biopsy specimens preoperatively and run specific histopathology tests, such as Glut-1 marker, to establish the correct diagnosis before treating a suspected hemangioma surgically.4
It is well known that, not so long ago, vascular anomalies where “baptized” as hemangiomas. Today, we also know that the surgical approach can be the last necessary step of therapy, and structured algorithms or decision trees concerning vascular anomalies need to be followed closely. The most important issue is correct diagnosis in the relatively new and constantly evolving field of vascular anomalies treatment.
The authors have no financial interest to declare in relation to the content of this communication.
Leonidas Pavlidis, M.D., Ph.D.
Georgia Alexandra Spyropoulou
Aristotle University of Thessaloniki
1. Goldenberg DC, Hiraki PY, Marques TM, Koga A, Gemperli R. Surgical treatment of facial infantile hemangiomas: An analysis based on tumor characteristics and outcomes. Plast Reconstr Surg. 2016;137:12211231.
2. Hoornweg MJ, Theunissen CI, Hage JJ, van der Horst CM. Malignant differential diagnosis in children referred for infantile hemangioma. Ann Plast Surg. 2015;74:4346.
3. Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R, et al. Cutaneous hemangiomas and vascular malformations and associated pathology (Pascual-Castroviejo type II syndrome): Study of 41 patients (in Spanish). Rev Neurol. 2005;41:223236.
4. Patiño-Seijas B, Lorenzo-Franco F, Rey-Sanjurjo JL, González-Cuesta M, López-Cedrún Cembranos JL. Vascular lesions: GLUT-1 expression as a diagnostic tool to discriminate tumors from malformations. J Oral Maxillofac Surg. 2012;70:23332342.
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