What is the treatment?

 
It is very important to make the appropriate diagnostic work-up in order to decide upon the appropriate treatment method. A dedicated and well-trained physician is a must in order to make the accurate diagnosis and treatment. It is very common to see patients who have been misdiagnosed and mistreated (or untreated) for years (50% or higher).
 

If the lesion (tumor) is Infantile Hemangioma, there is no need for treatment but close regular follow-ups are necessary to rule out tumor related problems (e.g., compression of the airway) or skin breakdown. In some patients, medical intervention may be indicated (using steroids either systemically or intralesional injections, or interferon). The tumor should gradually regress with steroids. Please click here for further information on treatment strategies for infantile hemangiomas.

If the diagnosis of Kaposiform Hemangioendothelioma (KHE) is made, more aggressive follow-ups (particularly regular check ups for platelets) and pharmacological treatment are needed. If the patient develops Kasabach-Merritt syndrome transcatheter embolization is the ideal treatment, although some small tumors may be removed surgically.

 

Venous malformation (or cavernous  hemangioma) lesions can be treated with sclerotherapy. Depending on the size of the venous malformation lesion, several sessions may be needed. Surgical removal of venous malformation is feasible for small focal lesions. Most patients describe "growing back" following surgery, and surgery may cause large tissue necrosis and scars. Venous malformations ("cavernous hemangioma") generally respond well to sclerotherapy (up to 70-80%).

Arteriovenous malformations (AVM) need to be treated with transcatheter or percutaneous embolization rather than by surgical excision. 

Lymphatic malformations or cystic hygroma lesions can also be treated by sclerotherapy, particularly macrocystic (cystic hygroma) and mixed form lymphatic malformations. Microcystic lymphatic malformations can only be treated with surgical excision (if possible). Radiofrequency ablation can be used in selected cases.

Klippel-Trenaunay syndrome is usually managed conservatively. Superficial varicoid veins can be sclerosed or removed surgically, but it is very important to check the patency of the deep venous system in these patients. Parkes Weber syndrome is generally approached in a similar manner to AVM lesions. Other combined anomalies are also managed conservatively in most cases, and intervention (either surgical or transcatheter such as sclerotherapy or embolization) is used in selected patients if needed. 

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