Effective Treatments for Hemangiomas: Surgery, Cryotherapy, or Observation?

What is the best treatment for vascular tumors?

My son, who is one year and three months old, has developed a hemangioma on his lower left lip, measuring approximately two centimeters in diameter.
It was not present at birth but began to appear when he was about two weeks old.
Over the next four months, it continued to grow, but since he turned five months old, its growth has slowed down, and it seems to have stabilized without further enlargement.
The lesion does not affect his feeding.
I consulted a plastic surgeon when he was two months old, and he was prescribed hormonal medication for over a month.
However, due to the lack of significant results, the doctor recommended surgical removal.
I also consulted a dermatologist, who suggested that we simply observe it, as most hemangiomas will resolve on their own.
Some dermatologists mentioned the option of cryotherapy.
What is the most effective and reliable method? What are the advantages and disadvantages of the three options: surgery, cryotherapy, and watchful waiting?

xin ji ru wen de fu qin, 30~39 year old female. Ask Date: 2004/01/29

Dr. Jiang Baicong reply Plastic Surgery

There are many treatment options for hemangiomas, especially in infants who have just been born.
Indeed, as you mentioned, there are surgical interventions, cryotherapy, and a watchful waiting approach, as well as the use of steroid injections or laser therapy.
In a study by Achauer (1997) involving 245 patients, the first group—observation (watchful waiting) included 48 patients and had poor outcomes; the second group—steroid injections included 9 patients; the third group—surgical excision and reconstruction included 27 patients; the fourth group—laser therapy included 88 patients; and the fifth group—mixed treatment modalities.
The statistical analysis showed that the outcomes of laser therapy (in terms of size and color) were significantly better than those of the observation group.
Reference: Achauer BM, Chang CJ, Vander Kam VM.
Management of hemangioma of infancy: review of 245 patients.
Plast Reconstr Surg.
1997 Apr;99(5):1301-8.

Reply Date: 2004/01/29

More Info

When it comes to treating hemangiomas, especially in infants, there are several options available, each with its own advantages and disadvantages. Hemangiomas are benign tumors made up of blood vessels and are quite common in infants. They often appear shortly after birth and can grow rapidly before eventually shrinking and disappearing over time.

Treatment Options
1. Observation (Watchful Waiting):
- Advantages: Many hemangiomas, particularly those that do not cause any functional impairment or cosmetic concerns, will resolve on their own without any intervention. This approach avoids the risks associated with surgery or other treatments.

- Disadvantages: The main downside is that it requires patience, as the natural involution process can take several months to years. There is also a risk that the hemangioma may grow larger or cause complications, such as ulceration or functional impairment, depending on its location.

2. Surgery:
- Advantages: Surgical intervention can be effective for hemangiomas that are large, symptomatic, or located in areas where they may cause functional issues (e.g., near the eyes or mouth). Surgery can provide immediate results and remove the hemangioma entirely.

- Disadvantages: Surgery carries risks such as anesthesia complications, infection, and scarring. It is usually considered when the hemangioma is not likely to resolve on its own or if it poses a risk to the child's health or quality of life.

3. Cryotherapy:
- Advantages: Cryotherapy involves freezing the hemangioma, which can lead to its shrinkage and eventual disappearance. It is less invasive than surgery and can be performed in an outpatient setting.

- Disadvantages: The effectiveness of cryotherapy can vary, and multiple sessions may be required. There is also a risk of skin damage or changes in pigmentation at the treatment site.

4. Medication (e.g., Corticosteroids):
- Advantages: Corticosteroids can help reduce the size of hemangiomas, especially if administered early in life. They can be effective in preventing complications associated with larger hemangiomas.

- Disadvantages: Long-term use of corticosteroids can have side effects, including growth suppression and other systemic effects. The response to medication can also vary from child to child.

Summary of Recommendations
Given your child's situation, where the hemangioma is not currently affecting his eating or causing other issues, a conservative approach of observation may be appropriate. Many hemangiomas will naturally regress without the need for intervention. However, if the hemangioma begins to grow significantly or causes functional problems, then surgical intervention or other treatments may be warranted.

It is essential to maintain regular follow-ups with a pediatric dermatologist or a specialist in pediatric vascular anomalies to monitor the hemangioma's progress. They can provide guidance on the best course of action based on the hemangioma's behavior and any changes that may occur over time.

In conclusion, the choice between observation, surgery, or cryotherapy should be made based on the specific characteristics of the hemangioma, its location, and any potential impact on your child's health and well-being. Consulting with a specialist who has experience in treating hemangiomas in infants will provide the best guidance tailored to your child's needs.

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