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December 1997, Vol 133, No. 12 >
Article | December 1997

Which Hemangiomas to Treat—and How?

Ilona J. Frieden, MD
[+] Author Affiliations

Departments of Dermatology and Pediatrics 400 Parnassus Ave, Box 0316 San Francisco, CA 94143-0316


Arch Dermatol. 1997;133(12):1593-1595. doi:10.1001/archderm.1997.03890480119022
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THE MANAGEMENT of hemangiomas has been a subject of intense controversy for many decades. Once the involuting nature of these benign tumors was recognized, the obvious question became, "Why would you want to treat something which will go away on its own?"1 The answer is that, despite the benign and trivial nature of most hemangiomas, a significant minority cause functional compromise or permanent disfigurement. To complicate matters further, hemangiomas are remarkably heterogeneous in terms of size, location, and rates of growth and involution.2 They are also notoriously unpredictable early in infancy: some barely grow, while others blossom forth into huge tumors. These clinical realities make decisions regarding treatment difficult, even for the most experienced of clinicians.3

Evaluating infants with hemangiomas requires that we remember one of the most basic principles of medical decision making: "First, do no harm." It is likely that the strongly anti-interventionist bias taught by many of

REFERENCES

1 +
Morelli JG.  Management of hemangiomas . Adv Dermatol. 1993;;8:327-345.
2 +
Frieden IJ.  Special symposium: management of hemangiomas . Pediatr Dermatol. 1997;;14:57-58.
3 +
Esterly NB.  Cutaneous hemangiomas, vascular stains and malformations, and associated syndromes . Curr Probl Dermatol. 1995;;7:65-108.
4 +
Jacobs AH.  Strawberry hemangioma: natural history of the untreated lesion . Calif Med. 1957;;83:8-10.
5 +
Margilth AM, Museles M.  Current concepts in diagnosis and management of congenital cutaneous hemangiomas . Pediatrics. 1965;;36:410-416.
6 +
Bowers RE, Graham EA, Tomlinson KM.  The natural history of the strawberry nevus . Arch Dermatol. 1960;;82:667-680.
7 +
Simpson JR.  Natural history of cavernous haemangiomata . Lancet. 1959;;2:1057-1059.
8 +
Enjolras O, Riche MC, Merland JJ, et al.  Management of alarming hemangiomas in infancy: a review of 25 cases . Pediatrics. 1990;;85:491-498.
9 +
Barlow C, Priebe CJ, Mulliken JB, Barnes P.  Neurotoxicity in the treatment of hemangiomas with interferon alpha 2a . In:Proceedings of the 11th International Workshop on Vascular Anomalies; June 24, 1996; Rome, Italy . Abstract.
10 +
Tamayo L, Ortiz DM, Orozco-Covarrubias L, et al.  Therapeutic efficacy of interferon alfa-2b in infants with life-threatening giant hemangiomas . Arch Dermatol. 1997;;133:1567-1571.
11 +
Teillac-Hamel D, DeProst Y, Bodemer C, et al.  Serious childhood angiomas: unsucessful alpha-2b interferon treatment: a report of four cases . Br J Dermatol. 1993;;129:473-476.
12 +
Frieden IJ, Eichenfield LF, Esterly NB, et al.  American Academy of Dermatology guidelines of care for hemangiomas of infancy . J Am Acad Dermatol. 1997;;37: 631-637.
13 +
Enjolras O, Mulliken JB.  The current management of vascular birthmarks . Pediatr Dermatol. 1993;;10:311-313.
14 +
Nakayama H.  Clinical and histological studies of the classification and the natural course of the strawberry mark . J Dermatol. 1981;;8:277-291.
15 +
Elsas FJ, Lewis AR.  Topical treatment of periocular capillary hemangioma . J Pediatr Ophthalmol Strabismus. 1994;;31:153-156.
16 +
Reyes BA, Vasquez-Botet M, Capo H.  Intralesional steroids in cutaneous hemangioma . J Dermatol Surg Oncol. 1989;;15:828-832.
17 +
Morelli JG, Tan OT, Yohn JJ, et al.  Treatment of ulcerated hemangiomas in infancy . Arch Pediatr Adolesc Med. 1994;;148:1104-1105.
18 +
Tanner JL, Dechert MP, Frieden IJ.  Growing up with a facial hemangioma: parental coping and adaptation . Pediatrics. In press.
19 +
Deans RM, Harris GJ, Kivlin JD.  Surgical dissection of capillary hemangioma . J Pediatr Ophthalmol Strabismus. 1994;;31:153-156.
20 +
Morelli JG.  Special symposium: management of hemangiomas . Pediatr Dermatol. 1997;;14:68-69.
21 +
Garden JM, Bakus AD, Paller AS.  Treatment of cutaneous hemangiomas by the flashlamp-pumped pulse dye laser: prospective analysis . J Pediatr. 1992;;120: 555-560.
22 +
Scheepers JH, Quaba AA.  Does the pulsed tunable dye laser have a role in the management of infantile hemangiomas? observations based on 3 years' experience . Plast Reconstr Surg. 1995;;95:305-312.
23 +
Ashinoff R, Geronemus RG.  Failure of the flashlamp-pumped pulsed dye laser to prevent progression to deep hemangioma . Pediatr Dermatol. 1993;;10:77-80.
24 +
Goldberg GN.  Special symposium: management of hemangiomas . Pediatr Dermatol. 1997;;14:71-74.
25 +
Apfelberg DB, Lane B, Marx MP.  Combined (team) approach to hemangioma management: arteriography with superselective embolization plus YAG laser/sapphiretip resection . Plast Reconstr Surg. 1991;;88:71-82.
26 +
Hobby LW.  Further evaluation of the potential of the argon laser in the treatment of the strawberry hemangiomas . Plast Reconstr Surg. 1983;;71:481-489.
27 +
Achauer BM, Chang C-J, VanderKam VM.  Management of hemangiomas of infancy: review of 245 patients . Plast Reconstr Surg. 1997;;99:1301-1308.
28 +
Castro-Ron G.  Cryosurgery of angiomas and birth defects . In: Zacarian SA, ed. Cryosurgery for Skin Cancer and Cutaneous Disorders . St Louis, Mo: Mosby— Year Book Inc; 1985;:77-90.
29 +
Cremer HJ, Djawari D.  Frühtherapie der kutänen Hämangiome mit der Kontaktkryochirurgie . Chir Prax. 1995;;49:295-312.
30 +
Ezekowitz RA, Mulliken JB, Folkman J.  Interferon alfa-2a therapy for life-threatening hemangiomas of infancy . N Engl J Med. 1992;;326:1456-1463.
31 +
Folkman J.  Clinical applications of research on angiogensis . N Engl J Med. 1995;; 333:1757-1763.
32 +
Mulliken JB.  A plea for a biologic approach to hemangiomas of infancy . Arch Dermatol. 1991;;127:243-244.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Morelli JG.  Management of hemangiomas . Adv Dermatol. 1993;;8:327-345.
2 +
Frieden IJ.  Special symposium: management of hemangiomas . Pediatr Dermatol. 1997;;14:57-58.
3 +
Esterly NB.  Cutaneous hemangiomas, vascular stains and malformations, and associated syndromes . Curr Probl Dermatol. 1995;;7:65-108.
4 +
Jacobs AH.  Strawberry hemangioma: natural history of the untreated lesion . Calif Med. 1957;;83:8-10.
5 +
Margilth AM, Museles M.  Current concepts in diagnosis and management of congenital cutaneous hemangiomas . Pediatrics. 1965;;36:410-416.
6 +
Bowers RE, Graham EA, Tomlinson KM.  The natural history of the strawberry nevus . Arch Dermatol. 1960;;82:667-680.
7 +
Simpson JR.  Natural history of cavernous haemangiomata . Lancet. 1959;;2:1057-1059.
8 +
Enjolras O, Riche MC, Merland JJ, et al.  Management of alarming hemangiomas in infancy: a review of 25 cases . Pediatrics. 1990;;85:491-498.
9 +
Barlow C, Priebe CJ, Mulliken JB, Barnes P.  Neurotoxicity in the treatment of hemangiomas with interferon alpha 2a . In:Proceedings of the 11th International Workshop on Vascular Anomalies; June 24, 1996; Rome, Italy . Abstract.
10 +
Tamayo L, Ortiz DM, Orozco-Covarrubias L, et al.  Therapeutic efficacy of interferon alfa-2b in infants with life-threatening giant hemangiomas . Arch Dermatol. 1997;;133:1567-1571.
11 +
Teillac-Hamel D, DeProst Y, Bodemer C, et al.  Serious childhood angiomas: unsucessful alpha-2b interferon treatment: a report of four cases . Br J Dermatol. 1993;;129:473-476.
12 +
Frieden IJ, Eichenfield LF, Esterly NB, et al.  American Academy of Dermatology guidelines of care for hemangiomas of infancy . J Am Acad Dermatol. 1997;;37: 631-637.
13 +
Enjolras O, Mulliken JB.  The current management of vascular birthmarks . Pediatr Dermatol. 1993;;10:311-313.
14 +
Nakayama H.  Clinical and histological studies of the classification and the natural course of the strawberry mark . J Dermatol. 1981;;8:277-291.
15 +
Elsas FJ, Lewis AR.  Topical treatment of periocular capillary hemangioma . J Pediatr Ophthalmol Strabismus. 1994;;31:153-156.
16 +
Reyes BA, Vasquez-Botet M, Capo H.  Intralesional steroids in cutaneous hemangioma . J Dermatol Surg Oncol. 1989;;15:828-832.
17 +
Morelli JG, Tan OT, Yohn JJ, et al.  Treatment of ulcerated hemangiomas in infancy . Arch Pediatr Adolesc Med. 1994;;148:1104-1105.
18 +
Tanner JL, Dechert MP, Frieden IJ.  Growing up with a facial hemangioma: parental coping and adaptation . Pediatrics. In press.
19 +
Deans RM, Harris GJ, Kivlin JD.  Surgical dissection of capillary hemangioma . J Pediatr Ophthalmol Strabismus. 1994;;31:153-156.
20 +
Morelli JG.  Special symposium: management of hemangiomas . Pediatr Dermatol. 1997;;14:68-69.
21 +
Garden JM, Bakus AD, Paller AS.  Treatment of cutaneous hemangiomas by the flashlamp-pumped pulse dye laser: prospective analysis . J Pediatr. 1992;;120: 555-560.
22 +
Scheepers JH, Quaba AA.  Does the pulsed tunable dye laser have a role in the management of infantile hemangiomas? observations based on 3 years' experience . Plast Reconstr Surg. 1995;;95:305-312.
23 +
Ashinoff R, Geronemus RG.  Failure of the flashlamp-pumped pulsed dye laser to prevent progression to deep hemangioma . Pediatr Dermatol. 1993;;10:77-80.
24 +
Goldberg GN.  Special symposium: management of hemangiomas . Pediatr Dermatol. 1997;;14:71-74.
25 +
Apfelberg DB, Lane B, Marx MP.  Combined (team) approach to hemangioma management: arteriography with superselective embolization plus YAG laser/sapphiretip resection . Plast Reconstr Surg. 1991;;88:71-82.
26 +
Hobby LW.  Further evaluation of the potential of the argon laser in the treatment of the strawberry hemangiomas . Plast Reconstr Surg. 1983;;71:481-489.
27 +
Achauer BM, Chang C-J, VanderKam VM.  Management of hemangiomas of infancy: review of 245 patients . Plast Reconstr Surg. 1997;;99:1301-1308.
28 +
Castro-Ron G.  Cryosurgery of angiomas and birth defects . In: Zacarian SA, ed. Cryosurgery for Skin Cancer and Cutaneous Disorders . St Louis, Mo: Mosby— Year Book Inc; 1985;:77-90.
29 +
Cremer HJ, Djawari D.  Frühtherapie der kutänen Hämangiome mit der Kontaktkryochirurgie . Chir Prax. 1995;;49:295-312.
30 +
Ezekowitz RA, Mulliken JB, Folkman J.  Interferon alfa-2a therapy for life-threatening hemangiomas of infancy . N Engl J Med. 1992;;326:1456-1463.
31 +
Folkman J.  Clinical applications of research on angiogensis . N Engl J Med. 1995;; 333:1757-1763.
32 +
Mulliken JB.  A plea for a biologic approach to hemangiomas of infancy . Arch Dermatol. 1991;;127:243-244.

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