Infantile hemangioma: clinical assessment of the involuting phase and implications for management

Abstract

Background: Infantile hemangioma involutes during childhood; the tumor decreases in size and its color fades. Reconstructive procedures are often withheld until the lesion stops improving. The purpose of this study was to determine the age at which involution of infantile hemangioma ends, and factors that influence its regression.

Methods: Consecutive patients with infantile hemangioma managed between 2007 and 2011 were studied retrospectively. The outcome variable was age at which the appearance of the infantile hemangioma ceased to improve. Predictive variables were sex, lesion size, location, tumor depth, ulceration, and history of treatment (local or systemic corticosteroid).

Results: The study comprised 81 patients. Infantile hemangioma was located on the head/neck (79.0 percent), trunk (13.6 percent), or extremity (7.4 percent). Average tumor area was 9.3 ± 9.7 cm. Twenty-six percent of the cohort was treated with a corticosteroid during the proliferative phase and 87.6 percent underwent reconstruction for a residual deformity. Kaplan-Meier analysis estimated that involution ceased at a median age of 36 months (interquartile range, 30 to 42 months), and 92 percent of tumors completed involution by 48 months. Multivariate Cox proportional hazards regression model showed that sex (p = 0.80), lesion size (p = 0.09), location (p = 0.77), tumor depth (p = 0.74), ulceration (p = 0.18), and previous local (p = 0.73) or systemic (p = 0.60) corticosteroid treatment did not influence regression.

Conclusions: Most infantile hemangiomas do not improve significantly after 3.5 years of age. Reconstructive procedures should be considered at this age; the tumor has been allowed to regress and the deformity is improved before the development of long-term memory and psychosocial morbidity.