Photo Rounds Friday Archive
Large red mass on face
Post Date: 8/7/09
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A 22-month-old girl was brought to the office by her mother because of the large red area on her face. The mother noted that it had been there since birth, grew larger during the first year of life, and had begun to shrink some. The mother wanted to know if it would go away, and if there was anything that could be done about it.
What's your diagnosis?
We diagnosed a strawberry hemangioma. Hemangiomas are the most common benign tumor of infancy and consist of an abnormally dense group of dilated blood vessels. While 30% are present at birth, the other 70% appear within the first few weeks of life. For some unknown reason, females are affected more often than males.
We told the mom that half of childhood hemangiomas completely involute by age 5, 70% by age 7, and the remainder take an additional 3 to 5 years to complete the process of involution. Of the lesions that have involuted by age 6, 38% will leave residual evidence of the hemangioma in the form of a scar, telangiectasia, or redundant, “bag-like” skin. The chance of a permanent scar increases the longer it takes to involute.
Fortunately the child had no problems with her vision. She had already been referred to an ophthalmologist, who confirmed that no treatment was needed despite the hemangioma’s proximity to the eye. For hemangiomas that block vision or other important functional organs, treatment options include oral propranolol, oral steroids, and laser therapy.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Madhukar M, Usatine R. Childhood hemangiomas. In: Usatine R, Smith M, Mayeaux EJ, Chumley H, Tysinger J, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:427-431.
To learn more about The Color Atlas of Family Medicine, see: