Hemangiomas are benign tumors that are made up of blood vessels that grow at a very rapid rate. These lesions tend to go away on their own, although they can enlarge very rapidly during infancy. Vascular malformations, on the other hand, are abnormally formed blood or lymph vessels that do not go away. They do not grow as a rapid pace, they are usually present at birth, and continue to grow along with your child throughout life.

This team is dedicated to the treatment of both hemangiomas and vascular anomalies. It meets every 2 months to discuss treatment of these anomalies and to develop a multidisciplinary treatment strategy, which optimizes the cosmetic and represents the most efficacious and rapid treatments for these problems. Many of these problems are chronic in nature and take years to treat properly. Carefully coordinated treatment is necessary so that services are not duplicated or that treatments that may seem good to one particular branch of medicine cannot impact negatively on the long-term outcome by compromising someone else's result. The team avoids a duplication or redundancy in services and maximizes the outcome for these kind of vascular birth anomalies.

1. Craniofacial surgeon (Dr. Stelnicki)
2. Pediatrician (Hematologist/Oncologist)
3. Dermatology
4. Interventional radiology
5. Clinical psychologist
6. Ophthalmologist 
   

Hemangiomas: What is a hemangioma? A hemangioma is a benign growth of blood vessels in the form of a tumor that are caused by an overgrowth of the cells that line these blood vessels. Hemangiomas typically grow very fast and often have unpredictable courses with the exception that in the end, they all to involute. The typical history for a patient with a hemangioma is that mom or dad noticed a small, red blemish somewhere on the body, which they thought was either a small birthmark or a scratch. This spot began to grow rapidly during what is called the proliferating phase. This proliferating phase can last up to a year. During this time, the growth of the lesion is typically very frightening to parents, and it is important to know that this hemangioma is not a cancer, but is actually a benign tumor, which will go away. At the end of the year, the rapid growth phase will be over. The growth will then plateau for a while and then the involution or shrinking phase will begin. This can last up to 7 years. The last phase is the involuted or shrunken phase. Here, hemangiomas have reached their final stage and, in many cases, will have completely resolved, leaving only a small patch of irregular skin in their wake. In some patients there may be some abnormal vascular markings still present or some fullness of the tissue.

We also know that hemangiomas occur in 1 in every 2000 newborns, which is about 10% Caucasian infants. Most hemangiomas are discovered in the first month of life. Girls are 3 times more likely to develop hemangiomas than boys. The sex of the child does not effect the rate and shrinkage of the hemangioma; 60% of all hemangiomas occur in the head and neck, and 10% of the effected babies have more than one hemangioma. When more than one hemangioma occurs in the same child they usually do not shrink at the same time or speed. The thickness of the hemangioma does not usually effect its final appearance, and the occurrence of ulcers can effect the final appearance after shrinkage, as some healed ulcers will leave noticeable scars that require surgical treatment. Most hemangiomas do not grow after the first year of life and once they shrink, they never come back.
Approximately 75% of hemangiomas will go away completely. Those that do not may retain some of their red color and extra loose skin. Some may have abnormal streaking blood vessels called telangiectasias in them, which need to be treated by injection or laser. Dr. Stelnicki and the vascular anomalies team can help you with all parts of treatment of these hemangiomas. A simple call to our office will get you on your way to proper treatment.

The color of the skin over the hemangioma depends on how far the hemangioma is away from the surface of the skin. Those that are right at the surface will be very red. However, those that are deeper will have a more purplish or bluish color. 
During the rapid growth phase, the hemangiomas can distort parts of the body's anatomy. They can ulcerate and occasionally bleed; however, this is usually controlled by local therapy alone. Occasionally, surgery is needed during the rapid growth phase if bleeding becomes a problem or if a significant vital structure is compromised by the growth of the lesion. If the hemangiomas are blocking the vision or airway, then surgical treatment is performed. In some patients, tracheostomy is required if airway compromise is severe in order to prevent life threatening complications of loss of airway and inability of the child to breathe. This is a rare complication of hemangioma, but it must be watched very closely in those that involve the mouth or around the trachea. Hemangiomas can occur in vital organs of the body, such as the liver, spleen, and other tissues and, these need to be followed closely by MRI. Our interventional radiologist will embolize hemangiomas that are life threatening or compromise a particular organ system.

The hematology oncology group working with Dr. Stelnicki will also recommend various medications, which can be used to either lessen the growth of the hemangioma or stop its growth completely. These medications can vary from anything from intralesional steroid use or extend up to more toxic drugs, such as interferon, vincristine, thalidomide, etc. The use of these drugs is carefully coordinated between Dr. Stelnicki and the hematology oncologist on the vascular anomalies team. Dr. Stelnicki will use a specific vascular laser to treat bleeding in ulcerated areas of the lesion. Laser therapy cannot completely eliminate hemangiomas and it is purely and adjunct therapy to other treatment modalities.

Most hemangiomas will go away without treatment. When hemangiomas begin to regress, there is often a change in color from a red color to a more grayish color. Some blue patches will start to mend together and the hemangioma will soften and begin to shrink. Injection with steroids typically speeds this process along. As the hemangioma begins to decrease in size, there may be some loose skin that can remain. This extra skin may have a texture of Crepe paper and require surgical treatment. By age 4 or 5, the hemangiomas will have completely involuted and surgical therapy, if needed, can be performed safely. Dr. Stelnicki is a pediatric plastic surgeon that is skilled in the treatment of these hemangiomatous lesions and will work with you to optimize the cosmetic outcome for your child. 

As most hemangiomas will go away, observation is desirable until the child is near school age, at which stage any residual deformity from the hemangioma will be removed so as the child can avoid psychosocial problems of having a hemangioma. It is important to understand that prior to school age, most children are not psychologically effected by the presence of a vascular birthmark, and as long as their parents love them, care for them, and nurture them, there is nothing that they need to be concerned about in terms of their long-term psychological development. We feel strongly about the need to treat these patient's prior to the kids going to school so that the teasing and ridicule can be diminished or halted altogether.

Special Hemangiomas.

a. Rapidly growing, bleeding, painful hemangioma. In the case of very large lesions, steroids are helpful in controlling the increase in size. Depending on the patient's age and the location of the lesion, steroids can be given either intralesional or orally. This pulse dose of steroids will frequently speed involution and decrease growth. Other centers will use drugs such as alpha interferon, but in our experience these drugs have a high complication rate without offering a significant benefit over steroid therapy or first time therapy.
b. The ulcerating, constantly bleeding lesion is first treated topically with antibiotic creams and non-stick coverings which prevent drying. If the bleeding persists, then a tunable dye laser, specially designed to treat vascular lesions, is used to coagulate the surface. Eventually, with laser and steroid therapy, these hemangiomas can be controlled.
c. Peri-ocular hemangiomas. Hemangiomas around the eye pose a particular threat. If during their growth phase they obstruct the eye, they can cause irregular eye movements (strabismus) or cortical blindness (amblyopia). Therefore these lesions need to be treated emergently by a combination of steroid therapy and direct excision. If the hemangioma is small, it will be completely excised. If the lesion is large, then a partial excision to remove the area of ocular obstruction is required. This excision frequently brings on an early involution, which further aides in the therapy.
d. Laryngeal hemangiomas. These lesions run the risk of obstructing the airway it untreated. Our otolaryngology staff will aggressively treat these lesions early, through the use of endoscopic laser in order to prevent airway compromise. Pediatricians will also institute oral steroids to help shrink the lesion. In most cases, this routine, plus a tracheostomy, is successful in protecting the child from a catastrophic event.