Hemangiomas and vascular malformations: unapproved treatments

Abstract

Hemangiomas are the most common tumor in infancy and early childhood. Abundance of cases in a career time of many physicians from various specialties provided a fertile ground for plethora of treatments. This review will present the various therapies that have been or are still used to treat hemangiomas and vascular malformations. The variable success rate precludes their recognition as evidencebased treatments, thus allowing their inclusion, at present, as unproven therapies. In the past, the abundance of therapies for vascular skin lesions could be attributed to misdiagnosis of vascular malformations as hemangiomas. In 1982, Mulliken and Glowacki defined the fundamental classification of vascular lesions based on biologic and pathologic characteristics. This initial classification has been recently revised to allow inclusion of rare forms of vascular tumors and malformations (Table 1). By definition, vascular tumors are proliferative lesions that gradually extend and/or enlarge, but also involute spontaneously. In contrast, vascular malformations are static nonprogressive lesions present since birth, although they tend to extend proportionally with child’s growth and may develop secondary changes later in adulthood. Concerning common infantile hemangiomas, the cosmetically unfavorable results with treatments available about five decades ago lead to a widely accepted conservative approach to leave these lesions untreated until spontaneous involution had occurred. Advances in understanding the natural course of the various vascular lesions and development of newer therapeutic options, however, tempt to challenge such an approach. In general, the therapeutic modalities for vascular lesions can be classified by the principal mode of action (Table 2 ). As the response to various therapies is different for vascular tumors and malformations, they should be assessed separately. Tables 3 and 4 summarize the reported therapies that had been or are still in use for vascular tumors and malformations, respectively.