Vulvar Hemangioma: A Review

Abstract

Objectives: To review the clinical presentation, diagnostic approach, treatment strategies, and outcomes of vulvar hemangiomas, and to evaluate the consistency of management practices in the absence of standardized guidelines. Eligibility criteria: We included case reports, case series, and observational studies describing vulvar hemangiomas with clinical, histological, and management data in human subjects. Reviews, editorials, and studies unrelated to vulvar hemangiomas were excluded. Information sources: Systematic searches were conducted in PubMed, Embase, Scopus, and Web of Science up to 20 February 2025, with additional citation tracking. Results: 85 studies were included. Data were synthesized narratively due to heterogeneity in the study design and outcome reporting. Most studies described symptomatic lesions presenting as swelling, bleeding, or pain, often misdiagnosed as Bartholin cysts or varicosities. Treatment varied widely, including observation, surgical excision, embolization, and medical therapies. No evidence-based guidelines were identified. Conclusions: Vulvar hemangiomas are rare and frequently misdiagnosed. While asymptomatic lesions may be observed, symptomatic cases require individualized treatment. This review highlights the need for diagnostic vigilance and the development of standardized management protocols. Further research is needed to optimize clinical outcomes.

Keywords: cavernous hemangioma; differential diagnosis; histology; vascular tumor; vulvar hemangioma.

Figure 1

Study flow chart.

Figure 2

A 69-year-old female complained of vulva nodules. Gross image of the vulvar hemangioma (black nodules over the left labia majora).

Figure 3

Histopathological examination of the vulvar lesion revealed a benign vascular neoplasm composed of large-caliber, blood-filled vascular channels lined by flattened endothelial cells and filled with erythrocytes (asterisks) without atypia or mitotic activity. These features are consistent with a diagnosis of cavernous hemangioma located in the vulva. ((A,B), H&E stain, 40× magnification; (C,D), H&E stain, 100× magnification).