From the Guidelines
Infantile hemangiomas are classified into several types, including superficial, deep, mixed, segmental, and focal hemangiomas, as well as special types such as PHACE syndrome and LUMBAR syndrome, according to the International Society for the Study of Vascular Anomalies classification system 1. The classification of infantile hemangiomas is based on their location, depth, and appearance.
- Superficial hemangiomas, also called strawberry hemangiomas, appear as bright red, raised lesions on the skin's surface.
- Deep hemangiomas, formerly known as cavernous hemangiomas, are located beneath the skin and appear as bluish swellings with normal overlying skin.
- Mixed hemangiomas have both superficial and deep components.
- Segmental hemangiomas cover a specific anatomical region or follow a developmental segment and are more likely to be associated with complications.
- Focal hemangiomas are localized to a specific spot. Special types of infantile hemangiomas include:
- PHACE syndrome (posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, and eye abnormalities), which involves large facial hemangiomas with associated structural abnormalities.
- LUMBAR syndrome (lower body hemangioma, urogenital anomalies, ulceration, myelopathy, bony deformities, anorectal malformations, arterial anomalies, and renal anomalies), affecting the lower body. Most infantile hemangiomas undergo spontaneous regression, but treatment may be necessary for those causing functional impairment, ulceration, or disfigurement, with propranolol being a commonly used treatment option 1. The American Academy of Pediatrics has published a report on the diagnosis and management of infantile hemangiomas, which provides guidance on the classification, clinical presentation, and management of these tumors 1. Additionally, the British Society for Paediatric Dermatology has published consensus guidelines on the use of oral propranolol in the treatment of proliferating infantile hemangiomas, which provides evidence-based guidance on the use of propranolol in clinical practice 1.
From the Research
Classification of Infantile Hemangiomas
The classification of infantile hemangiomas (IHs) is based on their clinical morphology and depth. According to 2 and 3, IHs can be classified into:
- Superficial IHs: appear as bright red, raised lesions
- Deep IHs: appear as blue or purple, bulging lesions
- Mixed IHs: have both superficial and deep components
- IHs with minimal or arrested growth: do not exhibit the typical rapid growth phase
Clinical Presentation
IHs can also be classified based on their clinical presentation, including:
- Localized IHs: oval or round, circumscribed lesions
- Segmental IHs: extend across a large anatomic area with a geographic shape
- Multifocal IHs: multiple lesions that can be associated with infantile hepatic hemangioma
- Indeterminate IHs: do not fit into any of the above categories
Subtypes and Associated Anomalies
According to 4, IHs can be classified into four subtypes:
- Localized
- Segmental
- Indeterminate
- Multifocal Segmental lesions are more likely to be associated with developmental abnormalities, such as PHACE syndrome and SACRAL syndrome, as mentioned in 2 and 3.
Depth and Distribution
The clinical appearance of IHs depends on their depth and distribution, as noted in 3. Superficial IHs are more likely to be visible, while deep IHs may not be as noticeable. Mixed IHs can have both visible and hidden components.