Case#18

 
History: 9 week old girl with a red somewhat raised lesion on her forehead. First noticed at birth by the Paediatrician. At that stage it was just a faint mark. By 4 weeks the lesion was starting to bubble and go dark red. It has continued to grow since and is now flatter in appearance along with dark blackish spots. There is normal skin around the lesion that is also raised. No treatment has been recommended. Mother: “I am concerned about the impact on her considering its location on her forehead... researching the pros and cons of having it removed now rather than later...I was told that laser surgery was not an option, however from reading your web site it appears that this may not be true. The lesion has grown a lot and is continuing to grow, as well as developing dark blackish spots..No imaging studies have been performed. I would sincerely appreciate your comments and direction as to whether I should keep trying other doctors or not regarding having it removed using Laser treatment”.

Imaging Studies: No imaging 

   

Diagnosis:  

This lesion is a typical infantile hemangioma lesion. In general, no imaging is needed. However, if there is concern for possible involvement of the skull or associated intracranial abnormalities, then MRI and/or CT would be appropriate. CT would be ideal at this age based on the fact that MRI generally requires sedation and sedation is not appropriate in patients younger than 6 months of age. Dr. Burrows states "imaging is needed in problematic hemangiomas of head and neck that do or may require pharmacological therapy, including hemangiomas of the orbit and airway or involving high risk "patterns" such as beard or regional distribution".   

Treatment / Recommendation:  

Most physicians who commonly deal with hemangiomas prefer "wait and see" , but some surgeons suggests an early surgical intervention. some dermatologist use laser, in this case it may help to some degree; however, using a phrase “having it removed using laser” is misleading. The laser usually works for very superficial lesions and generally recommended for complicated cases.  Some physicians would recommend steroid therapy, probably not needed in this case since it is not a very large lesion and there is no significant health risk. Embolotherapy is not an option due to the lesion's small size and also there is no significant potential health risks (e.g., hemorrhage). In summary, recommend searching for a surgeon/physician in your area who deals with hemangiomas commonly and follow his/her recommendations.

 

                                                                            

 

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