Hemangioma Excision Health Article

Diagnosis/Preparation

Initial correct diagnosis of the hemangioma is necessary for effective treatment. Generally, hemangiomas are not present at birth; they proliferate during the first year of the patient's life, and then commonly begin an involution process. These clinical characteristics distinguish hemangiomas from another type of congenital vascular lesion called a vascular malformation. Vascular malformations are always present at birth, do not proliferate, and do not involute. Vascular malformations are developmental abnormalities and can involve veins, arteries, or lymphatic tissue. Because of the lack of rapid proliferation, the expectation for vascular malformations differs from those with a hemangioma, and so the precise type of lesion has a significant impact on treatment decisions.

Aftercare

Aftercare for a hemangioma excision involves wound care and maintenance such as changing of bandages.

Risks

The greatest risk of hemangioma excision is bleeding during the operation, as these tumors are comprised of abnormal blood vessels. Surgeons often utilize special surgical tools to reduce this risk, including thermoscalpels (an electrically heated scapel) and electrocauteries (a tool that stops bleeding using an electrical charge).

A second risk of the surgery is recurrence of the tumor, that is, an incomplete excision of the abnormally growing tissue. Surgery may also result in scarring that is at least as noticeable as what would remain after involution, if not more so. Patients and their caregivers should carefully consider this possibility when deciding to undergo surgical treatment for hemangiomas.

Other risks of the surgery are very low, and include those that accompany any surgical procedure, such as reactions to anesthesia and possible infections of the incision.

Normal results

Completely normal appearance after surgery is very rare. However, for significantly disfiguring tumors or those that impact physical function, the surgical scar may be preferable to the presence of the tumor.

Morbidity and mortality rates

Morbidity and mortality resulting from this surgery is close to zero, particularly because of the new surgical techniques and tools that prevent intra-operative bleeding of the tumor.

Alternatives

Several alternatives to surgical excision include observation ("watchful waiting"), treatment with steroids during the proliferation stage to shrink the tumor and speed the involution process, and laser surgery techniques to alter the appearance of the tumor. Commonly, a combination of these treatment methods, including surgery, will be used to tailor a therapeutic approach for a patient's particular tumor.

BOOKS

DuFresne, Craig R. "The Management of Hemangiomas and Vascular Malformations of the Head and Neck." In Plastic Surgery: Indications, Operations, and Outcomes, Volume 2, edited by Craig A. Vander Kolk, et al. St. Louis, MO: Mosby, 2000.

Waner, Milton, and James Y. Suen. Hemangiomas and Vascular Malformations of the Head and Neck. New York: Wiley-Liss, 1999.

PERIODICALS

Mulliken, John B., Gary F. Rogers, and Jennifer J. Marler. "Circular Excision of Hemangioma and Purse-String Closure: The Smallest Possible Scar." Plastic and Reconstructive Surgery 109 (April 15, 2002): 1544.

ORGANIZATIONS

American Society of Plastic Surgeons. 444 E. Algonquin Rd. Arlington Heights, IL 60005. (800) 475-2784. <www.plasticsurgery.org>.

Vascular Birthmark Foundation. P.O. Box 106, Latham, NY 12110. (877) VBF-LOOK (daytime) and (877) VBF-4646 (evenings and weekends). <www.birthmark.org>.

OTHER

Sargent, Larry A. "Hemangiomas. " In Tennessee Craniofacial Center Monographs, 2000 [cited March 23, 2003] <www.erlanger.org/craniofacial/book>.

Michelle Johnson, MS,JD

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

The procedure is generally performed by plastic surgeons and, except for extremely small lesions, is done on an inpatient basis in a hospital operating room.

QUESTIONS TO ASK THE DOCTOR

• What is the predicted cosmetic outcome of the surgery and how does this compare to the outcome after involution?
• What are the risks of the surgery and how does this compare with the risks of continuing to observe the tumor?
• Is treatment of this hemangionma using steroids a possibility?
• Are laser techniques a viable option for this tumor?