When our daughter was one week old, a pink mark appeared on her cheek.  Since then the mark has grown to almost the size of a dime and has become bright red and slightly raised. Our pediatrician has told us it is a strawberry hemangioma birthmark and will most likely get bigger. We are upset because the mark is in a prominent spot and is the first thing people notice about our daughter. How large is it likely to get, and what, if anything, can be done to remove this mark?  Are there any medical complications that can occur because of this as well?

Pam LaVoy, Ft. Mitchell, KY

A growing mass on your beautiful child’s face can certainly strike terror in the heart of any parent.  Add to this the fact that this growth will continue to grow over the next year, and we start to really panic.  But take a deep breath, because the good news is that over 90% of the time these do go away on their own with good cosmetic result, and for those of you who want to be more aggressive, there are treatment options out there.  But first let’s learn a little about these strawberry hemangiomas.
What are strawberry hemangiomas?  Hemangiomas are simply a collection of dilated blood vessels that present at birth or develop within the first few weeks of life.  They start out as flat pink or red marks which quickly become raised over the first three to six months, sometimes growing to 2-3 inches in diameter.  This rapid growth is due to the establishment of new vessels and blood flow through these vessels.  Eventually they stop growing and enter a resting period before they start to involute, typically between six to twelve months. As they start to fade, the hemangiomas become softer, paler and finally islands of normal skin start to appear.  Most children’s hemangiomas have flattened by the time they are 5 to 9 years old, although a slight discoloration and change in skin texture may persist. 

Are there any risks or complications?  One concern is if the hemangioma is in a location that may interfere with their vision, breathing or hearing.  Once a hemangioma enters the rapid growth phase, its location to these essential functions warrants more aggressive treatment.  Also, some hemangiomas grow or shrink so fast that they form open sores.  These sores can be painful, bleed, become infected or even scar.  These need to be managed quickly as well.  Other complications include bleeding and bruising.  Since they are most commonly found on the face, scalp, chest or back, they are in highly visible areas, and therefore cosmetically may be concerning.

When should I contact my doctor?  Call your doctor if it grows rapidly over a couple days, starts bleeding, develops a sore or a bruise (which may herald an impending sore) or is painful. Obviously call if there is any risk to breathing, vision or hearing.

What are some options?  The good news is that most of these resolve on their own without any treatment.  Your pediatrician or dermatologist can monitor its growth to ensure a normal progression and involution. The other good news is that treatments have improved over time and we have better alternatives that lead to less scarring in the long run.

I must close this by adding that we exceptionally fortunate to live near one of the best children’s hospitals in the country.  Cincinnati Children’s Hospital has a Hemangioma and Vascular Malformation Center with physicians from several disciplines to adequately diagnose and treat different vascular malformations.  I have included their web site and phone number.  Good luck!

http://www.cincinnatichildrens.org/svc/alpha/h/vascular/

513-636-7742