Current perspectives on the optimal management of infantile hemangioma

Abstract

Infantile hemangiomas (IHs) are the most common benign tumor of infancy. As our understanding of their pathobiology has evolved, treatment has become more focused and tailored to specifically treat IH while minimizing adverse effects. Propranolol has gained FDA approval as the first medical therapy for a traditionally surgical disease. This review provides readers with an overview of IH, treatment modalities, and addresses specific considerations in IH disease management.

Keywords: complications of infantile hemangioma; infantile hemangioma; medical treatment indications; propranolol.

Figure 1

(A) A proliferating IH on the cheek of an infant. Note the ulceration in the center of the IH. (B) A proliferating IH is highly cellular with poorly defined vascular spaces (black arrowheads). Note: Magnification of image B, 40×; scale bar =50 µm. Abbreviation: IH, infantile hemangioma.

Figure 2

(A) An involuting IH on the arm of a toddler. Note the graying red color when compared to the proliferating IH. (B) Histology: involuting IHs have fewer cells and organized vascular tubular structures (black arrowheads). Note: Magnification of image B, 40×; scale bar =50 µm. Abbreviation: IH, infantile hemangioma.

Figure 3

Both proliferating (A) and involuting (B) IH endothelial cells express GLUT1 (green). Notes: Magnification, 40×; scale bars =50 µm. Right column indicates close-up views. Abbreviations: IH, infantile hemangioma; GLUT1, glucose transporter 1.

Figure 4

(A) Intraoperative photo demonstrating that IH can be easily separated from the surrounding soft tissue. Note facial monitoring devices in place. These can be used to assist during facial dissection. Course telangiectasia can be seen as well (arrowheads). (B) Feeding vessels to the IH need to be identified (black arrowhead) and isolated before dividing to minimize blood loss. Abbreviation: IH, infantile hemangioma.