Multiple Cutaneous Infantile Hemangioma and the Risk of Internal Hemangioma

Infantile hemangioma (ih) is a frequently occurring tumor in infancy of which the pathogenesis is not completely understood. Although ihs are self-limiting, they can cause problems during their active growth and therapy may then be indicated. Generally, screening for internal hemangiomas is recommended when five or more cutaneous ihs are present. This recommendation, however, is lacking solid scientific evidence. In this chapter, we discuss some controversies regarding the prevalence of ih, the nomenclature of “hemangiomas,” the nomenclature of multiple hemangiomas/hemangiomatosis, the therapy of ih, and the abovementioned screening recommendation. Since 1993, children with ihs have been evaluated in outpatient consultations by the working group on vascular anomalies rotterdam (wevar), using an approach protocol. This protocol aimed at determining the relation between number of ihs and the occurrence of internal hemangiomas. We included all patients presenting with five or more cutaneous ihs in the period of 1993–2011. These patients had all been referred for an ultrasound study for internal hemangiomas. We distinguished between children with ten or more ihs (hemangiomatosis group, group 1) and children with five to nine ihs (multiple ih group, group 2). Forty-three patients were included, 27 in group 1 and 16 in group 2. Nine infants in the hemangiomatosis group 1 showed internal hemangiomas versus none in group 2. Further examination for internal hemangiomas in children with fewer than ten cutaneous ihs is controversial and does not seem to be necessary. However, we do recommend ultrasound examination for children with ten or more cutaneous ihs.keywordscontroversyhemangiomahemangiomatosishepatic hemangiomainfantile hemangiomainternal hemangiomamiliary hemangiomahypoxiamultiple hemangiomapropranololrecommendationscreeningterminologytherapytreatmentultrasound.