Original article
Partially involuting congenital hemangiomas: A report of 8 cases and review of the literature

https://doi.org/10.1016/j.jaad.2013.09.018Get rights and content

Background

Congenital hemangiomas have been divided into 2 major subtypes based on clinical behavior: rapidly involuting congenital hemangioma (RICH) and noninvoluting congenital hemangioma (NICH).

Objective

We describe a clinical subtype of congenital hemangioma that begins as a RICH but fails to completely involute and persists as a NICH-like lesion. We propose the term “partially involuting congenital hemangioma” for this lesion with overlapping features.

Methods

A review of the medical charts, serial clinical photographs, imaging, and biopsies performed on children with a diagnosis of partially involuting congenital hemangioma between 2001 and 2012 at Centre Hospitalier Universitaire Sainte-Justine pediatric dermatology/vascular anomalies clinic was performed.

Results

Eight full-term, healthy infants presented at birth with vascular lesions typical of RICH. Affected locations included the head and neck, trunk, or extremities. Size varied from 2.0 × 1.5 cm to 13.0 × 8.5 cm. All had rapid involution during the first 12 to 30 months of life before stabilizing in size and appearance.

Limitations

Only a small number of cases were identified.

Conclusion

Partially involuting congenital hemangiomas are congenital hemangiomas with a distinct behavior, evolving from RICH to persistent NICH-like lesions. Their recognition and study will help us better understand whether RICH and NICH are indeed separate entities or simply part of a spectrum.

Section snippets

Methods

Between 2001 and 2012, 116 children with a diagnosis of congenital hemangioma were seen at Centre Hospitalier Universitaire Sainte-Justine pediatric dermatology/vascular anomalies clinic. We reviewed the medical charts, serial clinical photographs, imaging, and biopsy specimens of these children.

Results

We identified 8 patients (6.9%) with cutaneous lesions that could be categorized as partially involuting congenital hemangioma. Three male and 5 female full-term, healthy infants presented at birth with a vascular tumor involving the head and neck (n = 2), trunk (n = 3), or extremity (n = 3). The size of the tumor ranged from 2.0 × 1.5 cm to 13.0 × 8.5 cm and the clinical appearance uniformly included a red-purple color, telangiectasia, and surrounding pallor (Fig 1). Two lesions displayed

Discussion

Clinically, RICH and NICH have overlapping features. They show an equal sex distribution and typically present as solitary bossed plaques or flat infiltrative tumors of red to violaceous color with overlying tiny or coarse telangiectasia. Blanching or a halo-like effect may be seen surrounding the lesion. The most common locations are the head, neck, and limbs. Involution of RICH begins shortly after birth, and may present with crusting and scaling of the skin along with central fissuring and

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Funding sources: None.

Conflicts of interest: None declared.

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