Hemangioma, also known as angioma or vascular nevus, is a benign skin neoplasm that develops due to the localized accumulation and proliferation of small blood vessels, typically capillaries. These lesions are usually represented by flat or slightly raised, bright red formations that can vary in size and shape. Hemangiomas can be either congenital (present at birth) or acquired (appearing throughout life). The occurrence of multiple hemangiomas is especially common in acquired small hemangiomas, although congenital multiple forms (known as hemangiomatosis) also exist. Hemangiomas are equally common in both males and females, although congenital forms are more frequent in females.
The exact cause of hemangiomas remains unclear, but several factors are believed to increase the likelihood of their development. These predisposing factors can influence the formation of hemangiomas and their growth patterns:
The diagnosis of hemangiomas is generally based on a thorough clinical examination, including a visual inspection of the lesion and dermatoscopic evaluation to assess its structure. If there are concerns that the hemangioma may be malignant or if its growth is abnormal, a biopsy may be conducted to obtain a definitive diagnosis.
For congenital hemangiomas, which can sometimes be deep, cover large areas, or be located near vital organs and vascular structures, additional diagnostic procedures such as ultrasound may be necessary. In some cases, these lesions are part of congenital syndromes, such as Sturge-Weber syndrome, and require a multidisciplinary evaluation by several specialists.
Hemangiomas can present with various visual characteristics, depending on their type (congenital or acquired).
Congenital Hemangiomas: These lesions can take on many different shapes, including oval, asymmetric, or large masses that occupy multiple anatomical regions. The surface of the hemangioma may be smooth, especially in flat forms, or slightly bumpy, which is typical of more prominent hemangiomas that rise above the skin. The color can vary from pink to bright red, raspberry, crimson, or even cyanotic shades. The color is usually uniform across the lesion, although it may sometimes exhibit a spotted or variegated pattern. In general, congenital hemangiomas do not affect hair growth, although a few coarse or fluffy hairs may appear in the central area of the lesion.
The size of congenital hemangiomas can range widely, from small lesions just a few millimeters in diameter to large ones that occupy several anatomical regions (20-30 cm in some cases). On palpation, these hemangiomas are typically soft and more delicate than the surrounding skin. When pressed, they may briefly lose their color and pale. There are no associated sensations like pain or itching. Congenital hemangiomas are most commonly located on the head, face, and neck, although they can appear in other areas as well.
Acquired Hemangiomas: These lesions usually appear as small, hemispherical (sometimes on a narrow stalk), symmetrical nodules that protrude slightly above the skin. The surface may be slightly different from the normal skin texture, sometimes appearing smooth or even glossy. The color is generally bright red, but other shades of red may occasionally be seen. Like congenital hemangiomas, acquired hemangiomas do not affect hair growth. The size of acquired hemangiomas is typically small, usually up to 5-7 mm in diameter, although larger nodules may occasionally form. These hemangiomas are most commonly found on the trunk or upper limbs, though they can also develop on other parts of the body.
On dermatoscopy, the following features are typically observed in hemangiomas:
Hemangiomas should be differentiated from other neoplasms or lesions, including:
Hemangiomas are generally safe and do not carry a significant risk of malignant transformation. In the absence of external factors like trauma or UV exposure, the risk of malignancy is comparable to that of normal skin. However, signs that suggest possible malignancy include changes in the appearance of the hemangioma or the development of new symptoms such as pain or itching.
In addition to the small risk of cancerous transformation, hemangiomas—especially those that are large—can cause significant bleeding if injured. Additionally, large hemangiomas can ulcerate and become infected if they are subject to chronic trauma.
The management of hemangiomas depends on the size, location, and type (congenital or acquired). For large congenital hemangiomas, decisions about treatment should involve a team of specialists, including pediatricians, dermatologists, oncologists, and surgeons, among others. The timing of treatment interventions is determined on a case-by-case basis, considering the hemangioma’s impact on vital functions and the presence of other associated health issues.
For small acquired hemangiomas, if no changes in appearance or subjective symptoms are noted, no immediate treatment is required. Self-monitoring is sufficient, with periodic check-ups, especially in hard-to-see areas. If the hemangioma undergoes mechanical injury, changes in appearance, or the development of new symptoms, consultation with a dermatologist or oncologist is recommended.
For dynamic monitoring, it is helpful to take photographs of the hemangioma to track any changes over time. Patients with multiple skin neoplasms should be evaluated by a dermatologist or oncologist, ideally before and after the summer months (when sun exposure is more frequent). A skin neoplasm map can be beneficial for ongoing monitoring and the identification of new or altered lesions.
Treatment for hemangiomas typically includes less invasive methods:
If less invasive treatments are not possible or in cases of life-threatening conditions (e.g., bleeding), surgical removal may be required.
Given the high recurrence rate of hemangiomas, particularly congenital ones, multiple treatments or operations may be necessary over time.
In addition to the listed treatments, drug therapy (e.g., beta-blockers, steroids, and antitumor medications) may be used in cases of congenital hemangiomas.
Preventing the appearance of hemangiomas involves proper prenatal care, including minimizing stress, avoiding harmful drugs during pregnancy, and addressing infections promptly. To prevent further lesions or malignancy:
Regular examination of hemangiomas, prompt consultation with a specialist if any changes are observed, and removal of potentially harmful neoplasms are essential for managing skin health.
