Not All Hemangiomas Look Like Strawberries: Uncommon Presentations of the Most Common Tumor of Infancy

Abstract

The typical appearance of cutaneous hemangiomas of infancy is well known. We studied unusual manifestations of this common tumor. We reviewed over 500 hemangiomas in the registry of the Vascular Anomalies Program at Boston Children's Hospital. We found four uncommon morphologic variations: deep hemangiomas with normal overlying skin (n = 12); macular hemangiomas with a port-wine stainlike appearance (n = 6); bossed hemangiomas with telangiectasia and peripheral pallor (n = 5); and hemangiomas with persistent fast flow (n = 3). Deep and superficial (macular) varieties regressed at a normal rate. Telangiectatic (bossed) hemangiomas, however, involuted rapidly, usually before 1 year of age. Hemangiomas with persistent fast flow required either resection or sclerotherapy for complications in early childhood.