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DiDonna N, Khan K, Wood J. Infantile Scalp Hemangiomas: Surgical Management and Lessons Learned. J Craniofac Surg 2023:00001665-990000000-01191. [PMID: 37955432 DOI: 10.1097/scs.0000000000009816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/26/2023] [Indexed: 11/14/2023] Open
Abstract
Infantile hemangiomas (IH) are common benign vascular tumors in pediatric patients, often found on the scalp. While most IH naturally regress without intervention, surgical excision becomes necessary when severe anatomic or physiological complications arise. This review examines previously published case studies on pediatric scalp IH excisions, focusing on surgical outcomes and complications. A comprehensive search of the US National Library of Medicine National Institutes of Health (PubMed) database identified 19 relevant case studies. Most patients were female, with a wide age range at the time of excision. Various anatomic locations and sizes of the hemangiomas were observed. The reviewed literature demonstrates that surgical excision of scalp IH can be performed with minimal complications, even for sizable tumors. Successful outcomes and low complication rates highlight the effectiveness of surgical intervention in cases of life-threatening IH sequelae. Further research is warranted to explore optimal timing, techniques, and adjunct therapies for surgical management of scalp IH.
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Affiliation(s)
- Nicole DiDonna
- University of North Carolina School of Medicine, University of North Carolina
| | - Kamran Khan
- Division of Plastic & Reconstructive Surgery, University of North Carolina, Chapel Hill, NC
| | - Jeyhan Wood
- Division of Plastic & Reconstructive Surgery, University of North Carolina, Chapel Hill, NC
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Beqo BP, Gasparella P, Flucher C, Spendel S, Quehenberger F, Haxhija EQ. Indications for surgical resection of complicated infantile hemangiomas in the β-blocker's era: a single-institution experience from a retrospective cohort study. Int J Surg 2023; 109:829-840. [PMID: 36974689 PMCID: PMC10389552 DOI: 10.1097/js9.0000000000000324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/24/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND AND OBJECTIVES This study aims to review how the introduction of propranolol as the primary treatment option for children with infantile hemangiomas (IHs) has affected the use of other treatment options at our institution and to determine the indications for surgical treatment of children with IHs in the propranolol era. PATIENTS AND METHODS The authors conducted a single-center, noncompeting, historical/retrospective cohort study to review all cases referred to the institution for IH evaluation from 2005 to 2020. The authors analyzed the complete charts of patients who received surgery from 2011 to 2020 and evaluated the reasons for each surgical intervention. Detailed descriptive statistics are provided. Logistic regression analysis and Pearson's χ2 -test were applied. RESULTS During the study period, 592 children received treatment. From 2011, oral propranolol ( n =268; 74%) and surgery ( n =95; 26%) were the only treatments of choice for complicated IH cases. A significant decrease in the frequency of surgical treatment was observed ( P =0.01). The authors identified four main indications for surgical treatment: (1) patients with ulceration and IH size appropriate for surgical resection (15%); (2) patients whose parents preferred surgical treatment (19%); (3) patients who presented late and underwent surgery before the age of three (29%); and (4) patients with sequelae after IH involution and excision after the third year of life (37%). CONCLUSIONS Despite the significant decrease in the need for surgical treatment of children with IHs since the introduction of propranolol, there are still several clear indications for treating IH cases where surgery plays a crucial role.
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Affiliation(s)
- Besiana P. Beqo
- Department of Paediatric and Adolescent Surgery
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Stephan Spendel
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
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Bleve C, Conighi ML, Valerio E, Cutrone M, Iannucci G, Segna A, Chiarenza SF. Surgical management of large scalp infantile hemangioma in 30-month-old infant. LA PEDIATRIA MEDICA E CHIRURGICA 2022; 44. [DOI: 10.4081/pmc.2022.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Infantile Hemangiomas (IH) are the most common benign tumor of infancy, occurring in over 10% of newborns. The head and neck is the most frequently affected area (60%), and the scalp is a typical site for such large lesions. Scalp-IHs are usually focal lesions that can be both disfiguring and may lead to complications such as ulceration and bleeding. We describe a case of a 30-months old female who presented a large scalp-IH at birth that rapidly grew in the first year of life. Topical and systemic treatments (with timolol ointment and oral propranolol, respectively) were not effective in reducing dimensions of the hemangioma. After vascular imaging study, the patient underwent surgical resection of the IH and primary closure with excellent cosmetic outcome. When medical therapy is ineffective or cosmetic and functional integrity is threatened, early surgery allows to completely removing large scalp-IHs, with good cosmetic results.
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Abstract
Hemangiomas are common benign vascular tumors that often present in childhood. Diagnosis is based on clinical history, physical examination, and, when unclear, assisted with ultrasound or MRI. While the majority are small, nonproblematic, and can be managed conservatively, some hemangiomas may be associated with underlying syndromes or concerning for visceral involvement. Symptomatic lesions may develop ulceration, bleeding, vision disturbances, functional limitations, or disfigurement. The ideal treatment for a symptomatic hemangioma is often multimodal and may vary depending on the size, location, and proximity to critical structures. Medical treatments include topical beta blockers, oral propranolol, or steroid injections. Surgical resection and laser therapies may be necessary to optimize long term outcomes.
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Affiliation(s)
- Austin DeHart
- Otolaryngology, Head and Neck Surgery, Arkansas Children's Hospital at the University of Arkansas for Medical Science, Little Rock, Arkansas, 72202, USA
| | - Gresham Richter
- Otolaryngology, Head and Neck Surgery, Arkansas Children's Hospital at the University of Arkansas for Medical Science, Little Rock, Arkansas, 72202, USA
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Chen ZY, Wang QN, Zhu YH, Zhou LY, Xu T, He ZY, Yang Y. Progress in the treatment of infantile hemangioma. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:692. [PMID: 31930093 PMCID: PMC6944559 DOI: 10.21037/atm.2019.10.47] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023]
Abstract
Infantile hemangioma (IH) is a common benign tumor, which mostly resolves spontaneously; however, children with high-risk IH need treatment. Currently, the recognized first-line treatment regimen for IH is oral propranolol, but research on the pathogenesis of IH has led to the identification of new therapeutic targets, which have shown good curative effects, providing more options for disease treatment. This article summarizes the applications of different medications, dosages, and routes of administration for the treatment of IH. In addition to drug therapy, this article also reviews current therapeutic options for IH such as laser therapy, surgical treatment, and observation. To provide the best treatment, therapeutic regimens for IH should be selected based on the child's age, the size and location of the lesion, the presence of complications, the implementation conditions, and the potential outcomes of the treatment.
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Affiliation(s)
- Zhao-Yang Chen
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Qing-Nan Wang
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yang-Hui Zhu
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Ling-Yan Zhou
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Ting Xu
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Zhi-Yao He
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yang Yang
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
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Chang S, Yu W, Gu Y, Han Y, Shang Y, Chang L, Jin Y, Ma G, Qiu Y, Lin X. Location of infantile hemangioma is a predictor of volumetric sequelae after involution. J Dermatol 2019; 46:371-375. [PMID: 30888067 DOI: 10.1111/1346-8138.14847] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Shih‐Jen Chang
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Wenxin Yu
- Department of Laser and Aesthetic Medicine Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yifei Gu
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yue Han
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Ying Shang
- Department of Laser and Aesthetic Medicine Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Lei Chang
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yunbo Jin
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Gang Ma
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yajing Qiu
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Department of Laser and Aesthetic Medicine Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
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Satterfield KR, Chambers CB. Current treatment and management of infantile hemangiomas. Surv Ophthalmol 2019; 64:608-618. [PMID: 30772366 DOI: 10.1016/j.survophthal.2019.02.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 12/19/2022]
Abstract
Infantile hemangiomas, otherwise known as infantile capillary hemangiomas, strawberry hemangiomas, or strawberry nevi, are nonmalignant vascular tumors that commonly affect children. The natural disease course typically involves growth for up to a year, followed by regression without treatment over a period of years with no cosmetic or functional sequelae. Less commonly, however, infantile hemangiomas can become a threat to vision or even life depending on location and size of the lesion. In addition, infantile hemangiomas, particularly those involving the face, may be disfiguring and result in lifelong sequelae. β-blockers have become a mainstay of therapy given their relatively low-risk profile and efficacy. Other treatment modalities previously described in the literature include corticosteroids (both intralesional and systemic), imiquimod, vincristine, bleomycin A5, and interferon α. More recently, angiotensin-converting enzyme inhibitors such as captopril have been used. Laser therapy and, less commonly, surgical excision are also available treatment options. We review current recommended management and treatment of capillary hemangiomas and discuss the benefits and risks of all previously reported treatment modalities.
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Affiliation(s)
- Kellie R Satterfield
- Department of Medicine, Scripps Mercy Hospital, San Diego, California, USA; Department of Ophthalmology, University of Washington, Seattle, Washington DC, USA
| | - Christopher B Chambers
- Department of Ophthalmology, University of Washington, Seattle, Washington DC, USA; Department of Oculoplastic and Reconstructive Surgery, University of Washington, Seattle, Washington DC, USA.
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Hochman M. The Role of Surgery in the Management of Infantile Hemangiomas: What is the Best Timing? Otolaryngol Clin North Am 2018; 51:119-123. [PMID: 29217056 DOI: 10.1016/j.otc.2017.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Surgery for the management of infantile hemangiomas has become commonplace. Surgical technique articles are plentiful; however, little has been written about the timing of surgery. Knowledge of the biology of the tumors, data from developmental psychology, and the utility of facial reconstruction provide guidelines for timing of surgical intervention.
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Affiliation(s)
- Marcelo Hochman
- The Hemangioma and Malformation Treatment Center, Charleston, SC, USA.
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Charny JW, Moon AT, Treat JR. Scalp Infantile Hemangioma Complicated by Life-Threatening Bleeding. Pediatr Dermatol 2017; 34:473-475. [PMID: 28488296 DOI: 10.1111/pde.13171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report on an 8-month-old girl with an ulcerated occipital infantile hemangioma resulting in significant hemorrhage. The hemangioma responded rapidly to systemic propranolol and prednisolone, and we believe that describing her atypical clinical course would be helpful for others managing complicated scalp hemangiomas.
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Affiliation(s)
- Jacob W Charny
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amanda T Moon
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - James R Treat
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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