Conceptual Approach to the Management of Infantile Hemangiomas

Abstract

From the Department of Ophthalmology, HarvardMedical School, Boston, MA (A.F.); Ophthalmic Plastic and Reconstructive Surgery Division, Massachusetts Eye & Ear ore than a decade of medical and surgical innovation has produced a substantial array of interventional alternatives in the treatment of vascular anomalies. Advances in diagnostics, anesthetics, lasers, pharmacology, and surgery allow us to hasten the resolution of infantile hemangiomas and improve ultimate outcomes. The long-standing recommendation of passive observation is outdated; patients and their families have many new alternatives that are safe, effective, and available. The 1980s yielded a diagnostic revolution in the field of vascular anomalies, and the 1990s illuminated the immunohistochemically based pathogenesis of infantile hemangiomas. Surely the 2000s will be known for interventional progress in this field. Optimal treatment of hemangiomas involves cooperation in several disciplines, which has been facilitated by multidisciplinary teams at some medical centers in the United States and abroad. Treatment goals still include preservation of life and sight, but outward appearance, psychosocial health, and family dynamics must also be considered. In most instances now, some combination of interventions can indeed improve outcome. The initial decision to treat depends largely on location and size of the lesion, patient age, systemic involvement, and family desire. Developing a case-specific interventional strategy must consider, in addition to these factors, the subtype, stage, and depth of the hemangioma.We present a rationale for treatment selection and review emerging therapies available for patients with infantile hemangiomas.