Hemangioma is a common benign vascular formation.
Despite the possibility of self-healing and stopping the growth of hemangioma with subsequent disappearance, its further course still remains unpredictable.
Simple hemangioma – located on the skin surface;
Cavernous hemangioma – located under the skin;
Combined hemangioma – has subcutaneous and dermal parts;
Mixed hemangioma – consists of various tissues.
Simple hemangiomas have a red or blue-purple color, are located superficially, clearly delimited, affect the skin and a few millimeters of the subcutaneous fat layer, grow mainly sideways. The surface of hemangiomas is smooth, less often uneven, sometimes slightly protruding above the skin. When pressed, the hemangiomas turn pale, but then restore their color again.
Cavernous hemangiomas are located under the skin in the form of a limited nodular formation, soft-elastic consistency and consist of different-sized cavities filled with blood. Cavernous hemangiomas look like a tumor-like formation, covered with unchanged or bluish skin, with the growth of a vascular tumor, the skin becomes blue-purple. When pressed, the hemangioma subsides and fades (due to outflow of blood), when crying, shouting and coughing of the child increases and strains (due to blood flow).
Combined hemangiomas are a combination of superficial and subcutaneous forms (simple and cavernous). Manifested depending on the combination and the predominance of one or another part of the vascular tumor.
Mixed hemangiomas consist of tumor cells emanating from blood vessels and other tissues (connective, nervous, etc.). Appearance, color and texture are determined by the tissues that make up the vascular tumor.
In girls, hemangiomas are 2-3 times more common than in boys.
Usually they are found immediately after birth and much less frequently during the first two months of life.
The favorite location of hemangiomas is the head and neck area. The most rare localization in the head and neck is the parotid region.
Hemangiomas can be single or multiple.
The peculiarity of hemangiomas in the perineum and external genital organs is their tendency to frequent ulceration, which leads to self-healing of the tumor.
Diagnosis of hemangioma is carried out by a surgeon using the following methods:
Ultrasound (determination of the depth of the tumor and the calculation of the volume of education; specifies the location, structure of the tumor, measurement of blood flow velocity in the vessels).
Angiography (required when examining patients with extensive and deep hemangiomas)
Treatment of hemangiomas in most cases should be started as soon as possible, immediately after the diagnosis. The most effective treatment in the first weeks and months of a child’s life.
Surgical treatment is indicated for deeply located vascular hemangiomas, when it is possible to remove the entire formation, within healthy tissues, without significant cosmetic damage. Surgical treatment is also advisable to use in cases where the use of other therapies seems to be obviously ineffective. The success of treatment is achieved in 90% of cases. Postoperative complications are rare.
Hemangiomas of complex locations, primarily those areas where other methods of treatment cannot be used, such as the orbit, are subject to radiation treatment. Radiation therapy is also indicated for simple large area hemangiomas. Irradiation is carried out in separate fractions at intervals from 2-4 weeks to 2-6 months, until the hemangioma disappears. This method of treatment is relatively complex, and the effect occurs for quite a long time.
Diathermoelektrokoagulyatsii (cauterization) are subject to only small, point hemangiomas in cases where the tumor is located in areas inaccessible to another method of treatment. Electrocoagulation of extensive and deep formations should not be used. Some patients after electrocoagulation observed cosmetic defects.
Sclerotherapy is indicated for small, deeply located vascular hemangiomas of a complex location, especially when treating small cavernous and combined forms on the face and the tip of the nose. For injection use 70% alcohol. With combined hemangiomas, cryogenic or microwave cryogenic treatment is first carried out to kill the superficial part of the tumor, and then sclerotherapy . The disadvantages of sclerotherapy are pain and duration of treatment. The advantage of injection therapy over other conservative methods of treatment is its simplicity.
One of the methods of treatment of extensive hemangiomas of the integument in children is hormonal treatment. It is carried out by the hormone prednisone. The daily dose of prednisolone tablets is divided into 2 doses: at 6 am the child receives 2/3 doses, at 9 am – 1/3 doses. The drug is taken every other day without reducing the dosage. Duration of treatment is 28 days. If necessary, after 6-8 weeks, repeat the treatment. This method stops the growth of a vascular tumor. Treatment of hemangiomas after hormone therapy by other methods allows to solve cosmetic problems.
The widespread use of low-temperature exposure is associated with the use of special devices and freezing systems, which allows to expand the capabilities of the method. Due to such important properties as painlessness, absence of bleeding and noticeable general reaction of the body, the cryogenic method is widely used in the treatment of hemangiomas. All simple hemangiomas of a small area, of any location and at any age of the child are subject to cryogenic treatment. For therapeutic treatment, a cryogenic apparatus method is used, where liquid nitrogen is used as a cooling agent. The optimal duration of cryotherapyis 20-25 seconds for hemangiomas located on the skin and 7-10 seconds for hemangiomas located on the mucous membranes. The total area of cryotherapy should not exceed 10 cm2.
For simple hemangiomas, it is most advisable to use the cryogenic method.
In the treatment of large area simple hemangiomas, hormonal and radiation therapy are the methods of choice.
In cavernous and combined forms, the most effective sclerosing , surgical and microwave cryogenic methods.
With extensive and deep hemangiomas of the parotid area, complex treatment is effective, including mandatory angiography and hemangioma embolization.
The course of hemangiomas in most cases is benign. Modern methods of treatment allow you to choose the best treatment option for a particular patient. Cosmetic defects after treatment, as a rule, are absent or insignificant.