Diagnosis and Management of Infantile Hemangioma: Executive Summary
Infantile hemangiomas (IHs) are the most common tumors of childhood. Unlike other tumors, they have the capacity to involute after proliferation, often leading primary care providers to assume they will resolve without intervention or consequence. However, a subset of IHs may be associated with complications, resulting in pain, functional impairment, or permanent disfigurement. As a result, the primary care provider is often called on to decide which lesions should be referred for early consultation with a specialist.
This document provides a summary of the guidance contained in the clinical report “Diagnosis and Management of Infantile Hemangioma,” published concurrently in the online version of Pediatrics (Pediatrics. 2015;136:e1060–e1104, available at: www.pediatrics.org/content/136/4/e1060.full). The report is uniquely based on input from the many specialties involved in the treatment of IH. Its purpose is to update the pediatric community about recent discoveries in IH pathogenesis, clinical associations, and treatment and to provide a knowledge base and framework for clinical decision-making in the management of IH.
Infantile hemangiomas (IHs) are vascular neoplasms characterized by abnormal proliferation of endothelial cells and aberrant blood vessel architecture. In contrast, vascular malformations are structural anomalies and inborn errors of vascular morphogenesis. The latter include capillary malformations (port wine stains), venous malformations, lymphatic malformations (formerly known as lymphangiomas or cystic hygromas), and arteriovenous malformations.
Congenital hemangiomas are biologically and behaviorally distinct from IHs. They are fully grown at birth and present as 2 varieties: rapidly involuting (RICH) and noninvoluting (NICH).
Pyogenic granuloma, or lobular capillary hemangioma, is a reactive proliferative vascular lesion. Although classified with the vascular neoplasms and often misdiagnosed as IH, pyogenic granuloma is distinct in its clinical appearance and behavior.
Lesions diagnosed as “cavernous hemangiomas” are usually, in fact, deep IHs or venous malformations.
Kasabach–Merritt phenomenon (a consumptive coagulopathy) is not associated with IH but rather with …