1. Treatment of Hemangioma
Ahmad Abid Abas 2

2. Treatment
1. First line therapy : systemic therapy with steroids or beta blockers
solution/gel [Timolol] (still in clinical trials)
Observation ("watchful waiting") with steroids during the proliferation
stage to shrink the tumor and speed the involution process.
Medical Rx : Indications:
1. Mixed hemangiomas
2. Proliferative hemangiomas
3. Hemangiomas affects vital organs
4. Life threatening hemangiomas
• Oral CST.(prednisolone 3.0-5.0mg/kg body weight every morning for 6-8
weeks)
• Efficacy is 84%

3. Treatment
2. Small/Intermediate sized hemangiomas
Rx- Imiquimod (immunomodifier) alternate day topical
application.
• Disadvg : hyperpigmentation
3. Superficial proliferating hemangiomas/Hemangiomas at
involution stage:
Rx- Laser therapy + supplementary pharmacotherapy
Choice of laser : Flash lamp-pumped pulsed dye laser
Advtg : Selective destructions of B.Vessels,delivers
photocoagulation to targeted vessels while keeping
overlying skin intact.

4. Treatment
4. Subcutaneous and deep-seated hemangiomas (>2cm &
deep)
a) Laser Rx: Neodymium;yttrium-aluminium-garnet (Nd:YAG)
b)Percutaneous laser therapy.
Effectiveness : 77-100% for smaller lesion.
Side Effects :Tissue necrosis,scarring
5. Localized Hemangiomas : (orbital,parotid region)
Intralesional steroids:
Triamcinolone (1-2mg/kg) at monthly intervals,depend on
age of patient and size of the lesion.

5. Treatment
• Intralesional steroids :
Pingyangmycin (bleomycin A5) - specifically for hemangiomas based on
high sclerosing effect on vascular endothelium.
Efficacy: 90%,49% complete resolution.
Indications :
1. complicated cutaneous hemangiomas,
2. proliferative hemangiomas responds poorly to steroids/laser therapy.
• Hemangiomas unresponsive to steroids or rebound after steroids :
1. Vincristine
(0.5-1.0mg/kg given IV once a week over 6 weeks and then discontinued)
2. Alpha-Interferon (not recommended except in cases which other drugs
have been ineffective)

6. Treatment
• Surgery : (Hemangioma Excision)
• Aim : Remove or re-contour the residual
deformity,scar,hypertrophied abnormality,hyperpigmentation or
fibrofatty tissues to improve cosmetics and function.
• Indications:
1) Hg. located in the nose and lip that do not respond well to other Rx.
2) Hg.in the eyelids that impair sight and aesthetics.
3) Hg. occuring on the forehead and scalp.
4) Repeated bleeding fr hg.
5) Removal of residual deformities after conservative or laser therapy.

7. Treatment
• The most commonly used technique for small lesions
is very straightforward and involves removing
the abnormal vascular tissue with a lenticular,
or lens-shaped excision,that results in a linear scar.
A ) – Strawberry Hemangioma at the right cheek.
B) - The surgeon make incision around the mark
C) - Suturing the skin around it.
• http://www.surgeryencyclopedia.com/Fi-La/Hemangioma-Excision.html#b#ixzz2HPsWaR1g

8. Treatment
• Larger, more extensive lesions may
require angiography mapping of the vessel
 embolizationfollowed by complete
removal.

9. Treatment
•
• Angiogram of parotid hemangioma, sequential from early arterial to late venous phase (A–D). From
internal maxillary artery injection when performed at the time of planned endovascular embolization, it
demonstrates dilated feeding arteries, organized gland-like arterial angioarchitecture with a dense
parenchymal blush, and drainage into dilated adjacent veins.
• http://www.sciencedirect.com/science/article/pii/S105251490700010X

10. Treatment
• Aftercare for a hemangioma excision involves wound care and
maintenance such as changing of bandages.

11. Treatment
• For hepatic hemangioma, Kasabach Merritt
Syndrome,incapacitating pain,compression adjacent organ
and rupture are the only indication for surgical removal.
• When it is indicated, enucleation should be the procedure of
choice.
• Liver transplant – (rare cases of diffuse hepatic
hemangiomatosis,kasabach merritt syndrome)
• Conservative nonsurgical approach is always
advised.(analgesics) – liver resection presents with higher
mortality/morbidity rates compared to natural course of the
disease

12. References
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884763/
• Treatment Guideline for Hemangiomas and Malformations of Head and Neck
(Shanghai,China.& Arkansas Med. Science)
• http://www.surgeryencyclopedia.com/Fi-La/Hemangioma-Excision.html#b
• Surgical Treatment for Symptomatic Cavernous Hemangioma (Dept of
Surgery,Ankara University School of Medicine,Turkey)