Lesion Morphology in Multifocal Infantile Hemangiomas.

Abstract

Multifocal infantile hemangiomas (MIHs; previously called neonatal hemangiomatosis) can be associated with extracutaneous hemangiomas. We observed different morphologic types of hemangiomas in children with MIHs and sought to find out whether they are related to the clinical course. This was a retrospective study of 103 infants with MIHs and a control group of 261 age-matched patients with solitary focal infantile hemangiomas (IHs) seen at an academic pediatric dermatology department between 2004 and 2014. Two morphologic subtypes of hemangiomas were identified: miliary focal hemangiomas (MFHs; small, lens shaped) in 58 of 103 MIH patients (56.3%), and classical nonmiliary focal IHs (NMIHs; larger, irregularly shaped) in 17 of 103 patients (16.5%). MIHs featuring both types (mixed type) were observed in 28 of 103 patients (27.2%). MFH lesions were significantly smaller (mean 5.3mm [range 1-20mm] vs 22.0mm [range 2-100mm]), more numerous (23.4±27.3 [range 5-175] vs 7.4±2.8 [range 5-15] p<0.001), and occurred up to an older age (6.0±5.8months [range 0-27months] vs 3.8±2.6months [range 0-9months]) than NMIHs. There was a weakly positive correlation between the number and presence of extracutaneous IHs in children with MFHs. Significantly more children with MIHs were delivered preterm than those with solitary IHs. The number of IHs correlates inversely with their size. MFHs follow a clinical course different from that of classical IHs, are associated with prematurity, and may confer greater risk of extracutaneous hemangiomas. Miliary hemangiomas thus appear to present a separate IH subset requiring special attention.