Infantile hemangioma
Also called strawberry naevus, strawberry birthmark, capillary hemangioma
The commonest tumour of infancy, and a benign one: a vascular proliferation that appears in the first weeks, grows alarmingly for months, then involutes over years. The clinical job is triage, because a minority sit over airways, eyes, or spine, and those cannot wait for nature.
How it looks
A bright red, sharply demarcated, soft compressible plaque or nodule on an infant's skin, absent at birth and rapidly enlarging over weeks.
Rose is the lesion, grey the pattern the lesions make, green where on the body it lives.
Across skin tones
Superficial lesions read deep red to violaceous-brown rather than 'strawberry' in deeply pigmented infants, and deeper components present as bluish or skin-coloured swellings; post-involution textural and pigment change is also more visible.
Don't miss
Segmental facial hemangiomas (think PHACE), beard-area lesions over the airway, periocular lesions blocking vision, and midline lumbosacral lesions over the spine are the ones that cannot simply be watched.
Symptoms & course
- Appears days-to-weeks after birth, then grows fast for 3-5 months
- Painless unless ulcerated
- Involutes over years, sometimes leaving fibrofatty residue
Diagnostic approach
- Clinical for typical lesions
- Ultrasound or MRI for deep, segmental, or midline lumbosacral lesions
- Five or more cutaneous lesions: image the liver
Differential, and how to separate them
- Basal cell carcinoma
Favours it: A telangiectatic vascular-looking nodule
Against it: BCC belongs to sun-damaged adult skin; a proliferating vascular nodule in an infant's first weeks is a hemangioma
- Melanoma
Favours it: A rapidly growing vascular nodule can mimic amelanotic melanoma in adults
Against it: Age and the grow-then-involute arc are decisive; melanoma has no involution phase
Management principles
- Active observation with photographs for most, involution does the work
- Oral propranolol, the treatment revolution, for function- or cosmesis-threatening lesions, started early in the growth phase
- Ulcerated lesions: wound care, analgesia, and a lower threshold for treatment
Clinical pearl: 'Absent at birth, then grew fast' is reassuringly hemangioma; a fully formed vascular mark present ON the day of birth is a different diagnosis and a different conversation.
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