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Hemangioma treatment must begin sooner

Article

A new study finds that infantile hemangiomas begin growing much faster and earlier than previously thought, which means evaluation and treatment are occurring too late. Find out what experts now recommend.

A new study finds that infantile hemangiomas begin growing much faster and earlier than previously thought. In fact, growth is often complete by 8 weeks, with the most rapid period of growth often occurring between 1 and 2 months.

Researchers from the Mayo Clinic in Minnesota and from the University of California, San Francisco, reviewed serial photographs taken every 1 to 2 weeks for 6 months by the parents of 30 children with hemangiomas. They analyzed the photos for color and thickness of the lesions and for distortion of anatomic landmarks.

Growth of the tumors was nonlinear, with the most rapid period of growth occurring between 5.5 and 7.5 weeks. This put the mean optimal age for referral at 4 weeks. Traditionally, children do not visit subspecialists until aged 3 to 5 months.

Visible cutaneous precursors were present at birth or within the first day of life in two-thirds (65%) of the children, much higher than previously believed. Increased awareness of precursors is helpful in identifying infants to be followed, especially if the precursor is in a high-risk location or is large, suggesting segmental distribution.

The sample size was small and consisted of only head and neck hemangiomas that were mostly superficial in nature. Growth characteristics of superficial hemangiomas may not be generalizable to deeper hemangiomas, which can arise later in life and grow for longer periods of time.

Researchers believe that in order to optimize prevention of permanent disfigurement and functional compromise, a “paradigm shift” must occur in the timing of referral so that appropriate drug treatment or surgical removal can be executed before or early in the course of the period of most rapid growth and not after its conclusion.

Go back to the current issue of the eConsult.

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