Infantile Hemangiomas

An infantile hemangioma (IH) represents the most common benign tumor arising in infancy. IHs are distinct from other childhood vascular anomalies, including rapidly involuting and non-involuting congenital hemangiomas (RICH and NICH). The natural history of IHs is characterized by a proliferative phase during the first few months of life, followed by slower involution over several years. Variations in the typical growth pattern of IHs can occur, such as lesions with minimal or arrested growth. Cutaneous IHs are characterized as superficial, deep, and mixed lesions based on their clinical appearance. Extracutaneous IHs occasionally occur, such as airway and hepatic hemangiomas associated with cutaneous IHs in a “beard” distribution and multifocal small superficial IHs, respectively. In addition, larger IHs in a segmental pattern can be associated with regional extracutaneous congenital anomalies. Many IHs do not require active treatment and involute without leaving significant residua; however, some IHs are problematic due to potential disfigurement or complications such as ulceration and interference with a vital function (e.g. vision, patent airway). Early recognition of the IHs at greatest risk of complications is essential for optimal management. Discoveries related to the clinical and immunohistochemical features of IHs and medical therapy with β-blockers have significantly improved the management of complicated IHs.