Congenital Haemangioma
Introduction
Congenital haemangiomas (kuhn-jeh-nuh-tl huh-man-jee-ow-muh) are rare, harmless vascular (blood vessel) birthmarks which are present from birth and do not continue to grow after birth. The two main types are rapidly involuting which resolve usually within 12-14 months and non-involuting which stay the same size (which means they grow in proportion to your child as your child grows). The other form is partially involuting which may start to resolve but do not completely go away.
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Infant with a red vascular birthmark of congenital haemangioma on back of neck
Who gets it?
Boys and girls from all ethnicities have an equal risk of getting a congenital haemangioma. Three in 1000 babies are born with a congenital haemangioma. Very uncommonly, it can run in families.
What causes it?
The cause of these birthmarks is not completely understood. Most congenital haemangiomas have a mutation in the gene which seems to control the development of blood vessels and this is thought to cause the haemangioma to develop whilst the baby is still in the womb. This does not mean your child has any other genetic problem. It is not caused by anything the mother may or may not have done during the pregnancy.
What does it look and feel like?
Looks like…
A pink, purple or blue lump which is usually circlular or oval but can be any shape.
A pale rim of skin around the birthmark is usual and sometimes there are overlying red vessels.
It can get redder when baby is upset or crying.
Rarely, it can ulcerate and bleed.
Feels like…
A lump which is usually painless.
It can feel warm.
Rarely, it can ulcerate and bleed, which can be painful.
What tests might be needed?
These birthmarks may be picked up on a pregnancy ultrasound before your baby is even born. Otherwise, they are diagnosed by a paediatric dermatologist usually at birth from their classic appearance. Sometimes an ultrasound or even an MRI may be ordered to provide more information: to look at the blood flow, the depth of the birthmark and connection to other important blood vessels. If the diagnosis is uncertain, a biopsy may be taken where a small piece of your child's birthmark is removed to look under the microscope. Very rarely, if your child has a large haemangioma, they might need a blood test.
Although your doctor can diagnose the birthmark as a congenital haemangioma by simply examining it, it might take some time for them to confirm what type it is. In the weeks to months after birth, there will be signs to assist the doctor in determining whether the birthmark will resolve (rapidly involuting) or will remain unchanged (non-involuting).
What treatments are available?
What can I do?
Avoid knocking or bumping the birthmark as this can cause bleeding.
Apply a moisturiser regularly.
Monitor the lump in case it ulcerates or bleeds.
Medical therapies
Usually, your child will require follow up with a dermatologist to monitor how the birthmark resolves or for any complications. Most children do not require any treatment unless there are complications such as ulceration or bleeding.
If your doctor identifies that a treatment is required, then usually one of the below options is chosen to help shrink the congenital haemangioma:
Excision - surgery to remove the birthmark completely.
Pulsed dye laser - laser treatment to reduce the redness in the birthmark by shrinking the blood vessels.
Ligation - tying up the blood vessels that are feeding the birthmark.
Embolization - blocking the blood vessel feeding the birthmark with a tube.
What happens after treatment?
The outcome depends on the type of haemangioma your child has. An uncomplicated rapidly involuting type will usually self-resolve or involute itself within 13 months but can leave a pale area or excess skin where the haemangioma was. A non-involuting type usually grows in proportion to your child and will remain the same colour. A partially involuting type will shrink to some degree but part of it will remain life-long.
What support is available?
Your GP or paediatrician might refer your child to a paediatric dermatologist for monitoring.
Authors/Reviewers:
Author: Dr Chelsea Jones
Paediatric Reviewer: Dr Mayuri Sivagnanam
Editor in Chief: Dr Tevi Wain
