HEMANGIOMAS

Clues:
The 95% porcent involve at 9 years
If the aspect is not benign, or if it's ulcerated: prednisolone 2-3mg/kg/day
If it's something abnormal in the clinical review, emphasize with more studies.

Hemangiomas are proliferative hamartomas of vascular endothelium that may be present at birth or, more commonly, become apparent in the 1st 2 mo of life, predictably enlarge, and then spontaneously involute. Hemangiomas are the most common tumor of infancy, occurring in 1–2% of newborns and 10% of white infants in the 1st yr of life.

Girls are affected more often than boys. Favored sites are the face, scalp, back, and anterior chest.

The lesions are cystic, firm, or compressible, and the overlying skin may appear normal in color or have a bluish hue.

Hemangiomas undergo a phase of rapid expansion, followed by a stationary period and finally by spontaneous involution.

Regression may be anticipated when the lesion develops blanched or pale gray areas that indicate fibrosis. The course of a particular lesion is unpredictable, but ≈60% of these lesions reach maximal involution by 5 yr of age, with 90–95% by age 9.

Hemangiomas in a “beard” distribution may be associated with upper airway or subglottic involvement.

In the usual patient who has no serious complications or extensive growth that results in tissue destruction and severe disfigurement, treatment consists of expectant observation. Because almost all lesions regress spontaneously, therapy is rarely indicated and may cause further harm.

In the rare case in which intervention is required, if the lesion is very superficial, early therapy with PDL may be beneficial in decreasing growth of the hemangioma. PDL is also useful for the treatment of small (<4–5>

Syndromes associated with hemangiomas include PHACES (posterior fossa defects such as Dandy-Walker malformation or cerebellar hypoplasia, large plaquelike facial hemangioma, arterial abnormalities such as aneurysms and stroke, coarctation of the aorta, eye abnormalities, and sternal raphe defects such as pits or scars)