Vascular cutaneous anomalies in children: malformations and hemangiomas

The vast majority of cutaneous vascular anomalies in infants and children are either malformations or hemangiomas. Vascular malformations are subgrouped, based on channel morphology and rheology: slow-flow (capillary, lymphatic, venous, or combined-complex types) and fast-flow malformations (ectasia, aneurysm, fistula, or arteriovenous anomalies). Noninvasive radiologic techniques, especially ultrasonography with Doppler flow studies and magnetic resonance imaging, serve to document the extent and flow characteristics. Management depends on the type of malformation: laser for capillary malformations; surgical excision for lymphatic malformations; compression, sclerotherapy, and resection for venous malformations; and embolization and/or surgical resection for arteriovenous fistulae/malformations. Hemangiomas are the most common tumors of infancy. The life cycle is divided into three phases: proliferating, involuting, and involuted. Most hemangiomas do not require treatment, although drug therapy is indicated for endangering or life-threatening hemangiomas. Corticosteroids (either systemic or local) and alpha-2a interferon are currently the most effective agents. Surgical resection of problematic hemangiomas can be undertaken during infancy, the preschool years, or childhood.