Clinical characteristics of infantile hemangiomas with aggressive, persistent, and destructive ulceration

Abstract

Background/ObjectivesUlceration is a common complication of infantile hemangioma (IH). Severe, persistent ulceration occurs in a minority of patients. This study aims to characterize the clinical features of IH with aggressive ulceration (AU).MethodsMulticenter retrospective study of clinical features of IH with AU.ResultsThirty‐five patients with AU were identified and included in the study. The majority of AU occurred in segmental IH (23/35, 65%). Segmental IH with AU were large (≥10 cm2; 16/23, 69%, p < .001) with a thin (<3 mm) superficial component (16/23, 69%, p < .001). Localized IH with AU had a thick (>3 mm) superficial component (11/12, 92%, p < .001).All diaper area IH with AU (9/35) were segmental with thin superficial component (100%, p = .02). IH with AU in the head/neck (10/35) were more commonly localized (67%) and mixed (62.5%), while segmental, thick superficial morphology was more common on trunk (9/35) and upper extremities (7/35).ConclusionsIH resulting in AU differ in clinical features by anatomic site. Those in the diaper area are nearly always segmental with thin superficial component, whereas other sites tend to be localized, mixed, with thick superficial component. These distinct phenotypes may prove useful in the clinical setting for physicians to identify patterns of IH ulceration with increased risk of aggressive, persistent ulceration.

The CHIP Score: A Valuable Method for Determining Risk of Surgical Intervention for Hemangioma Patients

“…2 As the treatments for hemangiomas continue to evolve and improve, significant variability exists amongst institutions and practitioners regarding duration of medical treatment, timing of surgery, and referral to tertiary centers including surgical specialists. [3][4][5][6][7][8][9][10][11][12][13] Surgical intervention has traditionally been reserved for hemangiomas that fail to respond to medical management, with many clinicians advocating for medical treatment in the absence of impending medical or functional urgency, such as in the case of an airway-obstructing IH or periorbital IH that may result in amblyopia. 14 However, newer data indicate that early surgical intervention without prior medical treatment leads to equivalent outcomes in appropriate patients.…”

“…2 As the treatments for hemangiomas continue to evolve and improve, significant variability exists amongst institutions and practitioners regarding duration of medical treatment, timing of surgery, and referral to tertiary centers including surgical specialists. 3-13…”