Hemangioma surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

Surgery is not the first-line treatment option for patients with hemangioma. It is usually reserved for patients with either massive protuberant proliferating hemangioma and lesions that are refractory to less invasive treatments.

Surgery

  • Surgical management involves excision, laser treatment or both. [1][2]
  • Intralesional steroid treatment is also an option for focal hemangiomas such as:
    • Parotid
    • Nasal tip
    • Subglottis
    • Eyelid
  • Repeat therapy is often required, but systemic side effects are limited.
  • Excision is the appropriate for localized lesions the fibrofatty remnants (residuum) of involuted hemangiomas.
  • Elective subtotal excision of massive protuberant proliferating hemangiomas can be employed in order to maintain aesthetic facial boundaries.
  • Small remnants of disease are then left for involution.

Excision

  • Excision is the appropriate for localized lesions the fibrofatty remnants (residuum) of involuted hemangiomas.
  • Elective subtotal excision of massive protuberant proliferating hemangiomas can be employed in order to maintain aesthetic facial boundaries.
  • Small remnants of disease are then left for involution.

Phototherapy

Pulsed dye laser

Pulsed dye laser is considered to be effective choice for a series of skin disorders including superficial hemangiomas.[3]

  • Residual erythema and telangiectasias frequently remain in involuted hemangiomas and are best treated by selective photothermolysis using the flash pulse dye laser (FPDL).
  • Ulcerative lesions during proliferation can be treated with FPDL to induce healing and new epidermal growth.

Intense pulsed light

  • IPL flash lamps emit broadband polychromatic high-intensity light in the wavelength spectrum ranging 515-1200nm.[3]
  • They target vessels at various depths inside the skin.
  • The effect relies on selective photothermolysis.
  • The indication spectrum includes vascular tumors including hemangiomas.

References

  1. Callahan, Alison B.; Yoon, Michael K. (2012). "Infantile hemangiomas: A review". Saudi Journal of Ophthalmology. 26 (3): 283–291. doi:10.1016/j.sjopt.2012.05.004. ISSN 1319-4534.
  2. Richter, Gresham T.; Friedman, Adva B. (2012). "Hemangiomas and Vascular Malformations: Current Theory and Management". International Journal of Pediatrics. 2012: 1–10. doi:10.1155/2012/645678. ISSN 1687-9740.
  3. 3.0 3.1 Caucanas, Marie; Paquet, Philippe; Henry, Frédérique; Piérard-Franchimont, Claudine; Reginster, Marie-Annick; Piérard, Gérald E. (2011). "Intense Pulsed-Light Therapy for Proliferative Haemangiomas of Infancy". Case Reports in Dermatological Medicine. 2011: 1–5. doi:10.1155/2011/253607. ISSN 2090-6463.

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