Introduction
The hemangioma and vascular malformation program at the Institute of Reconstructive Plastic Surgery at the NYU Medical Center emphasizes comprehensive, multidisciplinary care. The team consists of specialists from Plastic Surgery, Dermatology, Hematology, Neuroradiology, Nursing, Ophthalmology, Otolaryngology, Pediatrics, Psychology, and Social Work.

What is a hemagioma?
A hemangioma is a type of birthmark. The word is derived from "hemangio" meaning blood vessel and "oma" meaning tumor. It is a benign growth.

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What is a vascular malformation?
A vascular malformation is another type of birthmark or congenital growth which is composed of blood vessels. There are several different types of malformations and they are named according to which type of blood vessel predominates. Hemangiomas and vascular malformations behave differently and are treated differently. It is important, therefore, for your doctors to make an accurate diagnosis.

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How common are hemangiomas and vascular malformations?
Hemangiomas occur in 1% of newborns. In premature babies the incidence is much higher, perhaps as high as 25%. They are less common in black children. Vascular malformations are less common than hemangiomas but, because there are so many different types of vascular malformations, it is difficult to give an accurate estimate of the incidence.

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What is the difference between a hemangioma and a vascular malformation?
Although we stated that hemangiomas are "birthmarks", the majority of hemangiomas are not present at birth. If they are present at birth, frequently the only evidence is a faint red mark. Shortly after birth they grow rapidly, out of proportion to the growth of the child. They then undergo a period of involution, during which they spontaneously become smaller and lighter in color. This gradual process of involution may take several years. Some hemangiomas disappear completely and others undergo only a partial involution. Vascular malformations, on the other hand, do not have a rapid growth phase and enlarge proportionately with the growth of the child. They never regress spontaneously and may become more apparent later in life.

Hemangioma of the right cheek before and after spontaneous involution with no treatment
Age 1 1/2	Age 4

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What are the different types of vascular malformations?
As mentioned above, vascular malformations are tremendously variable and are named for the type of blood vessel that predominates, such as capillary malformations (port-wine stains), venous malformations or lymphatic malformations. Some malformations, such as port-wine stains, cause only a change in skin color whereas other malformations are large, bulky growths which can distort normal structures. The various types of malformations have different characteristics, different growth pattems, different associated problems and different treatments. Once again, this reinforces the need to make an accurate diagnosis.

Capillary malformation (Port-Wine Stain) treated with laser
Before Laser Treatment	After Laser Treatment

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How are hemangiomas treated?
In the majority of cases, no treatment is recommended for hemangiomas and they are allowed to involute on their own. If the lesions do not disappear completely or if they disappear but leave scarring or redundant skin, surgical excision may be recommended later in life. Early medical and surgical intervention for hemangiomas is generally reserved for those rare hemangiomas which cause uncontrollable bleeding, growth disturbances, or impairment of vital functions such as vision, feeding or breathing. In such cases, treatment may consist of steroid medications, embolization (injection of material into the blood vessels to occlude the blood inflow) or surgical excision. Newer medications such as interferon are currently being investigated and show promise in the treatment of complicated hemangiomas.

Hemangioma of the face
Age 3 months	Age 5 after treatment with steroids followed by a perios of involution and finally surgical revision

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How are vascular malformations treated?
As stated above, each type of malformation is treated differently. Capillary malformations (port-wine stains), which tend to be flat red patches on the face, are usually treated by laser. Lymphatic malformations are most often treated surgically. Venous malformations are usually best treated by direct injection with a sclerosing agent which causes clotting of the venous channels in the malformation or with a combination of direct injection and surgery. Arterial malformations are best treated by embolization, in which material is injected under X-ray control into a normal artery in the vicinity of the lesion in order to block the inflow of blood into the malformation. Since malformations frequently occur as combined lesions consisting of more than one type of blood vessel, more than one type of treatment may be necessary (e.g. embolization followed by surgery).

Venous malformations of face and lip
Prior to Treatment	After Treatment With Direct Injection of Lower Lip, Surgical Revision and Application of Makeup

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What should I do if my child has a hemangioma or vascular malformation?
It is best to have the child evaluated by a multi-disciplinary team of medical specialists experienced in the management of children with hemangiomas and vascular malformations. Frequently it is difficult to differentiate between the various types of hemangiomas and vdscular malformations, making it especially important that an experienced team be involved. Because these growths can involve the eye, brain, respiratory tract and other organs besides just the skin, no single medical specialist is capable of caring for every aspect of these complex cases. The team includes dermatologists, nurses, ophthalmologists, otolaryngologists, pediatricians, plastic surgeons, psychologists, radiologists, social workers, and occasionally other specialists depending on what organs are involved.

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What other support is available?
It is often difficult for parents to deal with their own responses to their child's condition, in addition to the responses of other people. Forward Face (800-422-FACE), founded at the Institute of Reconstructive Plastic Surgery, is a self-help group consisting of patients and families affected with facial birth defects and is a helpful resource for families with these concerns. Hemangioma Hope (814-898-1054) is another self-help group, that was started by Cindy Dougan who has a child with a hemangtoma treated at the Institute.

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