What is the diagnosis and treatment for a scalp hemangioma?

From the Guidelines

Scalp hemangiomas should be treated with oral propranolol as the first-line therapy for lesions that cause complications such as bleeding, ulceration, or significant disfigurement, with a dose of 2-3 mg/kg per day, unless there are comorbidities or adverse effects that necessitate a lower dose 1. When managing scalp hemangiomas, it is essential to consider the potential risks and benefits of treatment. According to the clinical practice guideline for the management of infantile hemangiomas, oral propranolol is the recommended first-line treatment for lesions that require systemic therapy 1.

Key Considerations

• The diagnosis of scalp hemangioma is typically made clinically, but imaging studies such as ultrasonography or MRI may be necessary in certain cases, such as when the diagnosis is uncertain or when associated anatomic abnormalities are suspected 1.
• Treatment with oral propranolol should be initiated at a dose of 2-3 mg/kg per day, unless there are comorbidities or adverse effects that necessitate a lower dose 1.
• Alternative treatments, such as topical timolol 0.5% gel, oral corticosteroids, or laser therapy, may be considered for smaller lesions or for cases that do not respond to oral propranolol 1.
• Surgical excision is typically reserved for cases that do not respond to other treatments.

Monitoring and Follow-up

• Regular monitoring of heart rate and blood pressure is necessary when treating with oral propranolol 1.
• Parents should be educated about the expected natural history of scalp hemangiomas and the potential for complications or disfigurement 1.
• Close follow-up is necessary to monitor for any changes in size, color, or texture of the lesion that may warrant medical attention. In terms of specific treatment options, oral propranolol is the preferred first-line treatment for scalp hemangiomas that require systemic therapy, due to its efficacy and safety profile 1. Some key points to consider when treating scalp hemangiomas include:
• The importance of risk stratification to identify lesions that are at high risk for complications or disfigurement 1.
• The need for regular monitoring and follow-up to assess the response to treatment and to identify any potential adverse effects 1.
• The importance of educating parents about the expected natural history of scalp hemangiomas and the potential for complications or disfigurement 1.

From the Research

Diagnosis of Scalp Hemangioma

• Scalp infantile hemangiomas (IHs) are usually focal lesions that can be both disfiguring and may lead to complications such as ulceration and bleeding 2.
• The clinical features of scalp IHs include a size range of 1 × 1 cm to 8 × 6 cm, with 58% being solitary and 42% being multifocal lesions 2.
• The distribution of scalp lesions can be frontal (31.8%), parietal (46.7%), occipital (7.9%), or temporal (9.9%) 2.

Treatment of Scalp Hemangioma

• The aim of treatment is to counter the proliferative growth, reduce the volume of hemangioma, and initialize the process of regression 3.
• Treatment options for scalp hemangiomas include:
  • Wait and see policy (or close observation) for hemangiomas without visible growth or in the involutive phase 3.
  • Systematic drug therapy (such as steroids or propranolol) for large hemangiomas, multiple hemangiomas, or life-threatening hemangiomas 3, 4.
  • Sclerotherapy (using steroids or bleomycin) for growing hemangiomas 3.
  • Laser therapy (such as argon laser, flashlamp-pumped pulsed-dye laser, or Nd:YAG laser) for superficial or subcutaneous hemangiomas 3.
  • Surgical therapy (such as elliptical excision or rotational flap closure) for large hemangiomas, especially those causing alopecia or ulceration 2, 5, 6.
• Early surgical excision can be beneficial for scalp IHs, as the tissues are easily manipulated and scarring is more favorable 2.
• The goal of surgical intervention is to restore normal anatomic contour and shape while minimizing the size of the permanent scar 6.