Ear, Nose and Throat (Otolaryngology) – Head and Neck Surgery


Hemangiomas are the most common vascular birthmarks. Often referred to as infantile hemangioma, they appear within the first few weeks of child’s life and may grow for up to 12 months before undergoing a slow process of change and in many cases disappear.

Although hemangiomas can occur anywhere on the body, more than 60 percent are found on the head and neck. Usually, hemangioma will appear as a single mark (focal lesions); however, some patients may develop multiple hemangiomas (hemangiomatosis) or a hemangioma spread over a large area of the face or body (segmental).

Types of Hemangiomas

The different types of hemangiomas are as follows:

  • Superficial hemangiomas, or a "strawberry mark," will appear flat and bright red on the top layer of the skin.
  • Deep hemangiomas grow beneath the top skin layer, and may not be initially evident until later when they have grown to a noticeable size and protrude beneath the skin.
  • Compound or “mixed” hemangiomas involve both the top skin layer and the tissue below.

Risk Factors for Hemangiomas

Hemangiomas most often occur in the following groups:

  • Caucasians
  • Females
  • Twins
  • Patients with light skin
  • Babies with low­ birth weight or born prematurely

When to Consult a Birthmark Specialist

Because each case involving hemangiomas is different, the type and timing of treatment may vary from one patient to the next.

Wait and See Approach to Hemangiomas

Patients with a vascular birthmark should see a specialist at the four­-week well-baby check-up, or when it first appears. At this time, hemangiomas are just starting to grow and can be safely monitored. Patients will need monthly follow-ups for the first four­ to six months, as this is the period when most of the growth occurs. 

During these monthly evaluations, if the hemangioma remains stable (i.e., flat) or unchanged, the specialist will continue wait and see for any signs of changes. With close follow up, the vascular birthmark specialist is in a position to recognize any changes in size and/or thickness and begin treatment when necessary.

Early Intervention for Hemangiomas

While most hemangiomas remain small, each case is different and some hemangiomas may grow within critical areas that can be life­-threatening or cause functional impairment. Consult with a vascular birthmark specialist if the hemangioma is:

  • Impacting vision, breathing, eating, or hearing
  • Growing rapidly
  • Developing ulcerations  

Patients with multiple hemangiomas (more than five) may have a condition called hemangiomatosis and should also be evaluated by a birthmark specialist.

Cosmetic Treatments for Hemangiomas

Although in the past many doctors thought hemangiomas would simply "disappear" over time if left alone, it is now known that most children with hemangiomas on the face will require some form of treatment in order to achieve an acceptable cosmetic resultFor many children requiring surgery for hemangioma, the procedure can be done before the end of the first year of life, restoring the face and/or body to normal appearance, thus allowing the child to grow up and develop a normal sense of self­ awareness.