PEDIATRICS Vol. 36 No. 3 September 1965, pp. 410-416
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CURRENT CONCEPTS IN DIAGNOSIS AND MANAGEMENT OF CONGENITAL CUTANEOUS HEMANGIOMAS

A. M. Margileth M.D., F.A.A.P., F.A.C.P.1 and M. Museles M.D., F.A.A.P.2

1 Pediatric Service, United States Naval Hospital, N.N.M.C., Bethesda, Maryland
2 The Pediatric Service, United States Naval Hospital, Portsmouth, Virginia

SPONTANEOUS involution of hemangiomas in children was reported nearly 80 years ago and was further emphasized by Lister in 1938. However, among physicians considerable diversity of opinion still prevails regarding management of these lesions. Recent articles and texts continue to advocate or discuss therapy (surgery, radiation, dry ice, or injections of sclerosing agents) even though these authors mention that many hemangiomas will spontaneously subside. Our experience has shown that very few hemangiomas require any type of active therapy and that children in whom these lesions were treated had more complications than those managed conservatively.

Our current approach to management is based on a seven-year experience with over 200 children who had 340 hemangiomas. The seven common types encountered are listed (Table 1) in the practical classification used by most authors. Since the outcome of the tumorous types (strawberry, cavernous, and mixed) and erythema nuchae is one of gradual regression and involution whereas the course of many spider nevi and most port wine stains is lack of regression, a brief description of each type follows to facilitate diagnosis.

The common strawberry hemangioma or hemangioma simplex (Fig. 1) is a capillary hemangioma, usually bright red or purlish red with well-defined margins. It consists of myriads of tiny capillaries protruding above the skin surface. The strawberry [SEE TABLE I., FIG. 1A. and FIG. 1B. IN SOURCE PDF.] lesion blanches incompletely with pressure, and on palpation is a firm rubbery mass which compresses minimally if at all.

The cavernous hemangioma (Fig. 2) usually has poorly defined borders arising underneath the skin surface (hypodermal) or it may be well circumscribed and elevated above the surface (dermal). [SEE FIG. 2A. IN SOURCE PDF]

Submitted on January 25, 1965
Accepted on May 18, 1965




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