Capillary Hemangioma

Also classified as hamartoma, capillary hemangioma form when small blood vessels or capillaries proliferate abnormally, creating a small lesion. These may occur anywhere, but happen most often around the eye area, the face or the scalp.

Overview:

Capillary hemangioma is a relatively common condition involving the growth of a benign tumor composed of small capillary blood vessels that grow quickly and densely. These tumors in and of themselves are not dangerous and almost always recede over a period of several years. They occur almost exclusively in very young children between birth and one year. These lesions may continue to grow for several months or years from very small to several centimeters in diameter. Once the hemangioma has reached its full growth, it may take several years to recede.

The cause or causes of these hemangiomas are not understood nor is there a known way to prevent their onset. There are some common risk factors based on race and gender. Caucasian infants are more likely to develop them than other races. Females develop hemangioma more than twice as often as male infants and there is some evidence to suggest that infants born prematurely are at greater risk of developing hemangioma than infants born at full term.

While hemangioma are benign, they can cause issues with the patient’s vision or hearing, depending on where the growth develops. Generally, no treatment is required as the hemangioma will disappear on its own over time. However, careful monitoring of the growth and appearance of the tumor is very important. Should it become evident that the growth is impacting other physical functions such as vision or hearing, there are several recommended treatments. These might include the use of corticosteroids, immunodilators, and pulsed-dye laser treatments. While these first-line treatments are effective in treating the tumor, their use does carry some risk for the patient. Surgical excision is not often indicated as it comes with some risk. Hemangioma are difficult to remove because they are not solid masses and are generally not well encapsulated. The biggest issue most patients and their families face when a hemangioma develops is its appearance, particularly as they often grow in visible areas of the face. They most commonly develop around the eye area. Laser treatments may reduce the appearance of the hemangioma and can help limit its growth, but this treatment is not particularly effective when used alone. Typically, laser treatment is paired with the use of steroids or immunodilators when treatment is indicated.

Causes:

A direct cause or causes for capillary hemangioma have yet to be identified. While there are some populations that are more likely to develop the condition, the reasons for this increased risk are not understood.

Treatment:

Most capillary hemangioma go away on their own without any sort of treatment at all. Treatment is indicated in cases where the hemangioma is causing damage or affecting some other function of the patient. This might include vision impairment, particularly since the most common site for these tumors is around the eye area, including the eyelid, the eye itself or the orbital area around the eye. Treatments may follow any number of courses, but are always individual and specific to the patient being treated. Treatment may include the following:

  • Surgical removal: This is not a preferred treatment because the hemangioma is usually very difficult to remove. They tend to be unencapsulated and there is some risk of hemorrhage or uncontrolled bleeding. If surgery is indicated, results are generally better if the patient is less than a year old.
  • Other forms of removal: Methods such as radiation, cryotherapy, diarthermy or electrolysis have been used for this purpose in the past but are not considered best practice and are seldom used currently.
  • Corticosteroids: There are several different ways that steroids may be used in the treatment of capillary hemangioma. The delivery method may be oral (systemic), and this method is recommended when the patient’s vision is affected by amblyopia. It is also considered a first line treatment and has been in use since the 1960s. Delivery method may also be by injection (intralesional), where the treatment is injected directly into the lesion itself. This is also considered a first line treatment in cases where the hemangioma negatively impacts the vision of the patient. This treatment has been available since the late 1970s. The corticosteroid may also be delivered topically as an ointment applied directly to the lesion itself. This is generally not effective as a stand-alone treatment, but may be used as a secondary line of treatment. Topical treatment typically has fewer side effects, but has limited efficacy. All forms of steroidal treatment come with the potential of adverse effects such as gastrointestinal bleeding, skin hypopigmentation, eyelid necrosis, or immunosuppression. There may also be more serious damage done to the retinal artery and other vision issues.
    Immunomodulators: These medications function in a similar fashion as steroids in terms of suppressing or limiting the growth of the hemangioma. Medications such as Interferon alfa-2A have been used as treatment since the early 1990s, and are often used in conjunction with corticosteroids. These medications do come with significant risk of side effects and so it is considered best practice to keep the period of treatment as short as possible.
    Laser treatment: Also called laser photocoagulation, this form of treatment is used to address the appearance of the hemangioma, and may effectively reduce the size of the tumor itself. This treatment is not typically used alone, but in conjunction with other medication treatments. The benefit of pulsed-dye laser treatment is that it has very few side effects and may actually address appearance.
    • Regular ophthalmic and vision screening is vital for children with capillary hemangioma if there is some risk to overall vision. For hemangioma located near aural nerves, careful monitoring of hearing function is indicated as well.

Prevention:

It is not clearly understood what factors come together to cause the formation of capillary hemangioma, so it is not possible to prevent their onset. There are common risk factors, or populations that are more likely to develop them including babies born prematurely, females and Caucasian infants.