Vascular lesions are abnormalities of vascular elements that appear at birth or in infancy. Studies of the cellular features of cutaneous vascular lesions have identified two general types:
- Vascular malformations
Hemangiomas are vascular tumors that grow by cellular proliferation. Vascular malformations are tumors created by errors in morphogenesis or cell type.
The Vascular Lesion team at Rady Children’s consists of pediatric plastic surgery specialist Ralph Holmes, M.D., pediatric dermatologists, radiologists and surgeons experienced in the evaluation, imaging, diagnosis, and medical and surgical treatment of these conditions. When vascular lesions are extensive or they involve delicate features of the face, surgical treatment by a skilled pediatric craniofacial plastic surgeon can assure a more optimal outcome.
Hemangiomas are the most common benign tumor in infancy, occurring in 1 to 2 percent of all newborns. Hemangiomas are generally not recognized until they begin to grow after several weeks or months of life. Most occur as a single lesion and most occur on the head (60 percent).
A hemangioma is made up of endothelial cells, the kind that forms the lining of blood vessels. If close to the skin surface, it will appear raised and crimson, like a strawberry or raspberry. If deep to the surface the skin may be smooth with a bluish hue.
Hemangiomas undergo a phase of proliferation or rapid growth until the child is 6 to 10 months old, and then they slowly involute or disappear. By age 5 to 7 years, there may be little sign of the original growth in many children, and in other children a fibrofatty mass with pale and wrinkled skin may be left.
Critical structures that may be involved include:
- Eye orbit
- Ear canal
Complications such as ulceration, bleeding, disfigurement, and interference with vision, hearing, eating or breathing require active treatment. In these complex cases, steroid treatment, laser surgery, or reconstructive surgery may be needed.
Vascular malformations are diffuse lesions consisting of abnormal vessels which are present at birth and which grow in proportion to the child’s growth.
Vascular malformations are classified by the type of vessel involved:
Capillary, venous and lymphatic malformations are often mixtures of two or three of these vessel types, and there is a low flow rate through these vessels. Capillary malformations may present as port-wine colored stains. Venous malformations are soft, compressible, non-pulsatile spongy masses that may be localized or extensive. The overlying skin may be blue if the dermis is involved.
Even though vascular malformations are generally stable over time, it is important to receive an early evaluation to avoid complications with vital structures and bleeding.
Arterial malformations often have a venous component, and there is a high flow rate through these medium-sized arteries and veins. These lesions are pulsatile, and the turbulence of blood flowing through them can be felt (thrill) or heard (bruit). They occur most frequently in the head, and their high flow causes the overlying skin to be warm.
Diagnosis and treatment of vascular malformations can be difficult and require extensive evaluation by a vascular lesion team. CT and MRI studies are often necessary to identify the extent of a lesion and its flow pattern. A joint evaluation by the pediatric dermatologist, vascular radiologist and pediatric craniofacial plastic surgeon will help assure an accurate diagnosis, a complete treatment plan and an optimal cosmetic outcome.