Infantile Hemangiomas and Vascular Tumors
Featuring faculty, Dr. James Treat and Dr. Sheilagh Maguiness
Dr. Sheilagh Maguiness presented a comprehensive lecture reviewing infantile hemangiomas. She discussed the recent findings revealing how early in life infantile hemangiomas undergo rapid growth. This early rapid growth should encourage referrals to vascular specialists as early as 4 weeks. Furthermore, Dr. Maguiness discussed the 2019 AAP clinical guidelines for treatment of infantile hemangiomas. Indications for treatment include location, aesthetic compromise and ulceration.
Treatment of infantile hemangiomas include topical therapies, oral propranolol and pulsed dye laser. Oral propranolol is now considered the gold standard for treatment of infantile hemangiomas. This has changed dramatically over the last 10 years as corticosteroids used to be the main stay in treatment. Additional off label use of timolol was discussed in the treatment of infantile hemangiomas. It is important to note that sometimes ulceration may be the first clue of an infantile hemangioma.
Dr. Maguiness reports that oral propranolol is now considered the gold standard for treatment of infantile hemangiomas.
Next, Dr. Maguiness reviewed case presentations including a segmental hemangioma also known as “biker glove” presentation. Segmental hemangiomas are more likely to develop complications from ulceration. The treatment of these patients must include pain control. Additionally, Dr. Maguiness discussed concerning presentations of which to be aware including lumbosacral hemangiomas, multifocal infantile hemangiomas and PHACE syndrome.
Next, Dr. James Treat went on to discuss vascular anomalies including congenital hemangiomas. He reviewed the ISSVA classification system for vascular anomalies and pointed to this as an excellent resource for providers. Dr. Treat revealed it can be difficult for caregivers to recall if a hemangioma was present at birth or shortly thereafter. Congenital hemangiomas are present at birth, tend to stay the same or get better rapidly. Unfortunately, congenital hemangiomas are not responsive to oral propranolol, therefore, treatment typically involves waiting or excisional removal. It is important to remember these hemangiomas can have arterial flow to them.
Dr. Treat revealed that congenital hemangiomas are not responsive to oral propranolol, therefore, treatment typically involves waiting or excisional removal.
Lastly, Dr. Treat discussed various vascular tumors including fibrosarcomas, capillary malformations, tufted angiomas, microcystic lymphatic malformations and port wine stains. Dr. Treat illuminated many of these lesions have been found to be responsive to off label use of sirolimus. Thumb print oval capillary malformations was described as “red café au lait spots” and can be related to brain and spinal AV malformations, therefore, diagnosis and referral of these lesions is key.