From the Guidelines
Congenital hemangiomas are fully formed at birth and can be classified into rapidly involuting congenital hemangioma (RICH), non-involuting congenital hemangioma (NICH), and partially involuting congenital hemangioma (PICH), with treatment options depending on the subtype and clinical presentation. The size of congenital hemangiomas can vary, but they are typically well-defined, round or oval masses with a red-purple color, often with a pale halo and prominent blood vessels on the surface 1. They can occur anywhere on the body but are most common on the head, neck, and limbs.
Classification and Characteristics
The classification of congenital hemangiomas is based on their natural history and clinical behavior, with RICH lesions undergoing rapid involution within the first year of life, and NICH lesions remaining stable without growth or involution 1. The characteristics of congenital hemangiomas are distinct from those of infantile hemangiomas, which develop after birth and have a different natural history and response to treatment.
Management and Treatment Options
Treatment options for congenital hemangiomas depend on the subtype and clinical presentation, with observation often sufficient for RICH lesions, and surgical excision or other interventions considered for NICH and PICH lesions that cause functional impairment, pain, bleeding, or significant cosmetic concerns 1. Surgical excision is the primary treatment option for problematic lesions, though timing depends on location and associated complications. Embolization may be used pre-operatively to reduce bleeding risk in larger lesions, and laser therapy may help improve the appearance of residual lesions. Unlike infantile hemangiomas, congenital hemangiomas do not respond to propranolol or other beta-blockers 1.
Multidisciplinary Approach
The decision to treat congenital hemangiomas should balance the risks of intervention against the natural history of the lesion, with a multidisciplinary approach involving dermatologists, plastic surgeons, and interventional radiologists often providing optimal care for complex cases 1. This approach ensures that the best possible outcome is achieved, with consideration of the potential risks and benefits of different treatment options.
From the Research
Characteristics of Congenital Hemangiomas
- Congenital hemangiomas are fully formed at birth 2, 3
- They are caused by a point mutation in GNAQ or GNA11 2
- Congenital hemangiomas can be distinguished from infantile hemangiomas by their unique histologic and radiographic features 2
- They display a wide spectrum of clinical presentations 2
Classification of Congenital Hemangiomas
- Congenital hemangiomas are a distinct clinical entity from infantile hemangiomas 2, 3
- They can be classified based on their size, location, and clinical presentation 4
- Superficial lesions are bright red, protuberant, bosselated, or with a smooth surface, and sharply demarcated 4
- Deep lesions are bluish and dome-shaped 4
Management of Congenital Hemangiomas
- Surgical excision may be indicated due to the high risk of bleeding 2
- Oral propranolol is the first-line therapy for lesions that are at risk for life-threatening complications, functional impairment, ulceration, or permanent disfigurement 5, 4, 2
- Topical timolol may be considered for superficial infantile hemangiomas that need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse events from oral administration of propranolol 4
- Treatment should be individualized, depending upon the size, rate of growth, morphology, number, and location of the lesion (s), existing or potential complications, benefits and adverse events associated with the treatment, age of the patient, level of parental concern, and the physician's comfort level with the various treatment options 4