The hemangiomas are the most prevalent benign tumors of infancy and early childhood. Although they occur throughout the body, the most frequent site is the head and neck area.
Hemangiomas are composed of not only arterial, capillary, cavernous, and venous elements but also adipose tissue, fibrous tissue, lymphoid follicles and calcification. They do not represent proliferations of one cellular element. In this sense, most hemangiomas are hamartomas rather than true neoplasm.
The strawberry hemangioma is mostly composed of capillaries that have embryonal endothelium, 49-95% of which spontaneously involute within the first 7 years of life. The cavernous hemangioma involves a more mature endothelial cell organization and there is a 60 to 70 % chance of regression of all these lesions by the age of 8 years but the lesion of the lips seems to resolve less satisfactorily due to abundant blood supply and portwine hemangioma, which is composed of capillaries with adult endothelium and persists with little change during the person’s lifetime.
Today, hemangiomas have been treated by various means : the conservative method ; conscientious observation, local or systemic steroids, use of cosmetics, cryotherapy, compression, X-ray irradiation, use of cosmetics, and laser photo-coagulation, and also the surgical method ; dermabrasion, surgical tattooing, ligation or embolization of feeding arteries, and surgical excision.
The response of treatment varies with the type of hemangioma, region of the hemangioma, and the age of patient, and no completely satisfactory method of treatment has yet been established.
During the past 6 years and 3 months, from May, 1974 to August, 1980, a total of 309 patients visited our clinic and we have treated 95 patients with hemangiomas with systemic prednisolone, sclerosing agent, Dry Ice, and X-ray irradiation. The results were summarized as follows :
1) Females were affected about 2 times more than males and the most frequent site was the face (83%), among which the lip was the predominent site.
2) the most frequently involved age group was under 2 years, the next being 10-20 years of age, 20-30 years, of age, the pre-and post-school age groups respectively.
3) The number of clinical types of treated hemangiomas revealed 28 strawberry, 21 portwine stain, 41 cavernous and 5 mixed hemangiomas.
4) Systemic prednisolone was administered to 54 patients from age 1 month to 2 years for at least 2 weeks, and 25 patients were followed up.
Among these patients, one patient’s strawberry hemangioma was completely regressed, 5 patient’s strawberry hemangiomas were partially regressed, 7 patient’s cavernous hemangiomas were partially regressed, but there was no effect on mixed hemangiomas.
5) Sotradecol as a sclerosing agent was injected into 21 patients to the age of 7 to 32 years 1 to 4 times in intervals of 2 weeks. The most frequent injection site was the lower lip and 14 patients were followed up. Among these patients, 1 patient’s cavernous hemangioma on the lower lip had completely disappeared, 9 patient’s hemangiomas had partially regressed and 4 patient’s had no effect.
6) Dry Ice was applied on 16 patients with facial portwine stain hemangiomas to the age of 16 to 24 years, 1 to 5 times at intervals of 2-3weeks. among these patients, 7 patients were followed up. Four patients had improved, 2 patients had no change, I patient became worse.
7) Radiation was given to 4 patients. 1 patient with a cavernous hemangioma on the upper lip had radium needle insertion and improved, and 2 patients with cavernous and portwine stain hemangiomas involving the lower extremities had some improvement.
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