Characterization and Management of a Rare Recurrent Pediatric Papillary Hemangioma

Papillary hemangiomas (PHs) are rare, benign vascular tumors, typically described in adults. Few pediatric cases have been reported, and recurrence is uncommon. We presented a unique case of PH in a 15-month-old male patient with recurrence after surgical excision. The patient presented with a left cheek lesion present since birth, which had grown proportionally with his development. Initial ultrasound demonstrated a superficial, hypoechoic, heterogeneous lesion with increased vascularity. Surgical excision was performed, and pathology demonstrated large, thin-walled, irregular vascular channels with arborizing fronds, eosinophilic hyaline globules, and CD31+ endothelial cells, findings consistent with PH. Four months postoperatively, imaging revealed recurrence. Re-excision was performed, including branching structures initially thought to be nutrient vessels. Nitro paste was applied postoperatively due to concern for the thin overlying skin. PH is rarely congenital and can be misdiagnosed as other vascular anomalies. This case emphasized the importance of recognizing branching structures that may represent lesion extensions to optimize complete excision. Multidisciplinary management is recommended for diagnosis, treatment planning, and follow-up.