From the Guidelines
For a scalp hemangioma follow-up, I recommend regular monitoring by a pediatric dermatologist or vascular anomalies specialist every 3-6 months, depending on the hemangioma's size, location, and growth pattern. Most infantile hemangiomas undergo spontaneous involution and don't require treatment 1. However, if the hemangioma is causing complications like ulceration, bleeding, or functional impairment, treatment with oral propranolol (starting at 1 mg/kg/day divided into 2-3 doses, gradually increasing to 2-3 mg/kg/day) is the first-line therapy 1. Treatment typically continues for 6-12 months with regular monitoring of heart rate, blood pressure, and blood glucose. Topical timolol 0.5% gel (applied twice daily) may be used for smaller, superficial lesions.
During follow-up visits, the physician will document changes in size, color, and texture of the hemangioma through photographs and measurements. Parents should watch for signs of ulceration, infection, or rapid growth between appointments. The natural history of infantile hemangiomas involves a proliferative phase (rapid growth in the first 5-7 months of life), followed by a plateau phase, and then a gradual involution phase that can take several years 1. Complete resolution may leave minimal residual changes, but some cases might require laser therapy or surgical intervention for cosmetic concerns after involution.
It is essential to educate parents about the natural history of infantile hemangiomas, including the fact that involution proceeds at 10% per year, and that 50% of IHs resolve by 5 years of age and 90% by 9 years of age 1. A collection of serial photographs can be useful to demonstrate to parents the natural history of IHs and the process of spontaneous involution. Recognizing that it may be difficult to obtain an appointment with a hemangioma specialist in a timely manner, caregivers and clinicians may need to advocate on behalf of the infant, and telemedicine triage or consultation can be helpful 1.
A hemangioma specialist may have expertise in dermatology, hematology-oncology, pediatrics, facial plastic and reconstructive surgery, ophthalmology, otolaryngology, pediatric surgery, and/or plastic surgery, and his or her practice is often focused primarily or exclusively on the pediatric age group 1. Regular monitoring and timely intervention can significantly improve the outcomes and quality of life for infants with scalp hemangiomas.
From the Research
Follow-up for Scalp Hemangioma
The follow-up for a scalp hemangioma can vary depending on the size, location, and treatment of the hemangioma.
- For small hemangiomas, a wait-and-see approach may be taken, with regular follow-up appointments to monitor the size and growth of the hemangioma 2.
- For larger hemangiomas, surgical excision may be necessary, with follow-up appointments to monitor the healing of the wound and the growth of the surrounding hair 3.
- In some cases, scalp hemangiomas can be associated with more serious complications, such as hydrocephalus and venous sinus thrombosis, and may require more frequent follow-up appointments and imaging studies 4.
Treatment Options
The treatment options for scalp hemangioma can vary depending on the size, location, and symptoms of the hemangioma.
- Surgical excision with primary closure or rotational flap closure may be necessary for larger hemangiomas or those that are causing symptoms such as ulceration or alopecia 3.
- Circular excision with purse-string closure can result in a smaller scar and minimal distortion of the surrounding anatomy 2.
- In some cases, embolization followed by debulking may be necessary for large cranial base lesions 5.
Complications
Scalp hemangiomas can be associated with several complications, including: