Hemangiomas, vascular tumors, and other vascular (blood vessel-related) anomalies are potentially disfiguring lesions that cause distress for affected children and their parents and confusion among physicians and surgeons. Although advances have been made in the diagnosis and treatment of these lesions, many myths, misconceptions, and inaccuracies remain.
To address this situation, the editors of The Journal of Craniofacial Surgery, in collaboration with the American Association of Pediatric Plastic Surgeons, have invited leading international experts to share their views on the current concepts and controversies in treating children with vascular anomalies. The results appear in a Special Section of the July/August issue of JCS.
Over the years, physicians and surgeons have held widely divergent, often inaccurate views regarding vascular anomalies, according to an introductory editorial by Dr. Mutaz B. Habal, Editor of JCS. Hemangiomas, the most common vascular anomaly, are vascular "birthmarks" that can enlarge rapidly. Because many hemangiomas are located on the head and neck, they may cause serious cosmetic problems. Depending on location, damage to the eye or other structures can also occur.
A major problem is that many doctors have been taught that all hemangiomas "will disappear within a short time." However, Dr. Habal writes, "This is absolutely not true...These vascular tumors do not disappear like magic." Some hemangiomas do shrink over time, but may leave behind an area of baggy skin. Others grow very large, causing serious disfigurement if untreated. For many patients, this widespread misconception has led to delays in treatment, cosmetic and psychological issues for the child, and problems with scarring when surgery eventually is performed—not to mention a "windfall for litigation," according to Dr. Habal. Confusion over diagnosis leads to inaccurate identification of vascular tumors and further delays in treatment.
Fortunately, recent years have seen progress in the understanding of vascular anomalies and the development of appropriate treatment protocols. The 20 articles in the Special Section offer "a thorough synopsis" of current scientific understanding of vascular anomalies, their clinical appearance and development, the associated problems, and the treatment options, according to Section Editor Dr. Seth Thaller of the University of Miami.
Dr. Thaller stresses the need for multidisciplinary evaluation to ensure precise identification of vascular anomalies. This information is vital for management decisions—whether it is appropriate to monitor the lesion or to recommend one of several treatment options, alone or in combination.
The development of effective laser techniques has been a major advance in the treatment of vascular anomalies. In a new treatment advance, laser treatment may be performed "intralesionally"—from the inside out. When needed for larger, more complex vascular lesions, modern surgical techniques and skin grafts provide good results. If these procedures are done in childhood, any resulting scars are more easily managed by plastic surgery later on. In some situations, certain drug therapies may play a role.
Several articles in the Special Section outline the current treatment strategies and techniques for patients with hemangiomas and other vascular anomalies. Some authors focus on specific approaches for patients with more complex or rare vascular lesions. Others highlight advances in understanding genetic factors contributing to the development of vascular lesions, which may one day lead to new treatment alternatives.
The goal of the Special Section is to draw attention to the need for a rational, scientifically based approach to diagnosis and treatment of vascular anomalies. Dr. Thaller writes, "Successful management of these challenging lesions requires vigilant planning and diagnosis, proper clinical judgment, thorough knowledge of a range of treatment modalities, indications for intervention, and appreciation of procedure associated peril." The Editors hope that continued scientific and clinical research will lead to new therapeutic advances, "providing our patients and families with new hope for superior outcomes."