A cavernous hemangioma is a common, benign vascular lesion that can affect the skin. It is a type of birthmark or vascular anomaly. While they can appear at birth or develop during infancy, they are often self-resolving, particularly in children.
What is a Cavernous Hemangioma?
Cavernous hemangiomas are characterized by their appearance as reddish-blue, purplish, or brownish lumps on the skin, depending on skin tone and depth. They can have a spongy texture and vary in size from a few millimeters to several centimeters, sometimes even exceeding 5 centimeters, at which point they are referred to as giant hemangiomas. These lesions are typically found on the head and neck, but can also appear on the trunk, limbs, or on mucous membranes like inside the mouth or on the tongue.
These formations are a type of vascular malformation, involving abnormal clusters of dilated blood vessels. Unlike capillary hemangiomas, which are more superficial, cavernous hemangiomas form in deeper layers of the skin. They consist of thin-walled, dilated blood vessels, forming large, blood-filled spaces where blood flows slowly.
Cavernous hemangiomas are benign. However, their location and size can sometimes lead to complications. They are also known by other names, including cavernous angioma, venous malformation, or cavernoma.
Identifying and Diagnosing Cavernous Hemangiomas
The appearance of a cavernous hemangioma on the skin, such as a noticeable lump or discoloration, often prompts individuals to seek medical attention. While many hemangiomas are asymptomatic, some may cause discomfort, pain, or a tingling sensation, especially if they grow large or are located in sensitive areas. Growth of the lesion can also be a reason for concern.
A medical professional typically begins the diagnostic process with a physical examination of the affected area. During this examination, the doctor will assess the lesion’s size, location, and characteristics. If there is a family history of such conditions, a consultation with a geneticist might be suggested.
To further confirm the diagnosis and assess the depth or extent of the hemangioma, imaging techniques may be employed. Ultrasound is a non-invasive method that uses sound waves to create images of internal structures, revealing abnormal vascular patterns. Magnetic Resonance Imaging (MRI) is often the preferred method, utilizing powerful magnetic fields and radio waves to provide detailed images. A specific type of MRI, susceptibility-weighted imaging (SWI), can detect even tiny hemangiomas and signs of past bleeding.
CT scans, which use X-rays, can also provide detailed pictures and detect abnormal vascular patterns. In certain cases, a biopsy, involving the removal and microscopic examination of a small tissue sample, may be necessary to confirm the diagnosis.
Management and Treatment Approaches
The management of cavernous hemangiomas often begins with “watchful waiting” or observation, particularly for lesions not causing symptoms or complications. This approach is common, especially in children, as many hemangiomas may naturally regress or shrink over time. However, if a hemangioma grows beyond expected normal growth or has been present for several years without regression, active treatment may be considered.
When intervention becomes necessary due to size, location, or impact on function or appearance, several treatment options are available. Medications can be used, with corticosteroids historically employed, and propranolol being a more recent discovery for proliferating hemangiomas. Propranolol is often used for complicated infantile hemangiomas on the skin, airway, or liver.
Laser Therapy
Laser therapy is another option, particularly for superficial lesions or to reduce their size. Various types of lasers are used depending on the depth and nature of the lesion.
Sclerotherapy
Sclerotherapy involves injecting a sclerosing agent directly into the abnormal blood vessels. This causes the vessels to close off and scar, leading to the shrinkage of the hemangioma. It is often effective for larger or rapidly growing lesions.
Surgical Removal
Surgical removal may be considered for lesions causing problems or in locations where other treatments are less effective. This can include open surgery, often guided by imaging.
Embolization
Embolization, performed by an interventional radiologist, can block the blood supply to the malformation before surgery or as a primary treatment.
Outlook and Living with a Cavernous Hemangioma
The prognosis for individuals with cavernous hemangiomas is favorable, as many lesions resolve or shrink over time without intervention. However, the outlook can vary based on the lesion’s size, number, and location.
Despite their benign nature, cavernous hemangiomas can lead to potential complications. Bleeding is a concern, with the risk of rupture increasing significantly if the lesion has bled previously. Bleeding can manifest as ulceration on the skin or, in deeper locations, can cause more serious issues like hemorrhagic stroke, particularly if in the brain. Other complications depend on the affected area; for instance, those near the eye can cause vision problems like double vision or reduced visual acuity due to compression. Spinal cord lesions can lead to neurological symptoms such as numbness, weakness, or paralysis.
Living with a visible cavernous hemangioma can also have a psychological impact, necessitating ongoing support. Regular monitoring by a healthcare provider is important, especially for larger or symptomatic lesions, which may involve periodic imaging scans to track changes and assess for potential complications. While most hemangiomas do not affect life expectancy, complications from bleeding can affect quality of life. Recovery after surgical removal typically takes around six weeks, and physical rehabilitation may be needed if neurological deficits occur.