Guidelines of care for cutaneous haemangiomas

Haemangiomas are common benign tumours of the vascular endothelium. They are extremely heterogenous clinically, with size, location and rate of proliferation having a significant effect on the risk of complications.

The available evidence in the literature was evaluated using the grading system currently employed by the Ministry of Health, Singapore.

An uncomplicated haemangioma can be observed for spontaneous involution. However, some haemangiomas may be life- or function-threatening, or have associated structural anomalies. Corticosteroids may be used topically, intralesionally or systematically. Interferon alpha, vincristine and cyclophosphamide are therapeutic options for complicated haemangiomas which do not respond to corticosteroids. Vascular-specific pulse dye laser therapy may be considered for superficial haemangiomas, ulcerated haemangiomas or post-involution sequelae like telangiectasia. The mainstay of therapy for ulcerated haemangiomas is good local wound care, analgesics and treatment of secondary infection. A periorbital haemangioma that obstructs the visual axis or exerts pressure on the globe is an ocular emergency. Systemic corticosteroids and patching of the unaffected eye should be considered.

Medical practitioners should be aware of available therapeutic options for life- or function-threatening haemangiomas. Treatment must be individualised and referral to the relevant specialist should be considered in patients with complicated haemangiomas.