Hemangiomas are benign growths of blood vessels, and while they are commonly associated with infants, they can also appear in adults. Infantile hemangiomas often develop shortly after birth and may shrink over several years. Adult hemangiomas, however, typically do not go away on their own and present with different characteristics and management strategies compared to their childhood counterparts.
Understanding Adult Hemangiomas
Adult hemangiomas are an overgrowth of blood vessels. They are generally benign, meaning they are not cancerous and do not spread. These growths can appear as small, round or oval-shaped spots, usually red or purple in color.
While infantile hemangiomas are often visible on the skin, adult hemangiomas can also form in deeper layers of the skin or internal organs. Common locations include the skin, liver, and spine. Diagnosis typically involves a physical examination, and imaging techniques such as MRI, CT, or ultrasound may be used for deeper or internal lesions. In some cases, a biopsy might be performed for confirmation.
When Treatment Becomes Necessary
Many adult hemangiomas are asymptomatic, causing no discomfort or functional issues, and therefore only require monitoring. However, treatment becomes necessary when the hemangioma causes symptoms or complications. These can include pain, bleeding, or ulceration, particularly if the lesion is in an area prone to friction.
Cosmetic concerns can also prompt treatment, especially if the hemangioma is disfiguring or causes psychological distress. Functional impairment is another reason for intervention; hemangiomas affecting organ function, vision, or mobility. Complications like mass effect, compression of nerves or blood vessels, or, rarely, high-output heart failure, also necessitate treatment.
Non-Surgical and Minimally Invasive Treatments
Observation is a common approach for asymptomatic and stable adult hemangiomas. If intervention is required, several non-surgical and minimally invasive options are available. Medications like beta-blockers (e.g., propranolol) are primarily used for infantile hemangiomas, but can sometimes be considered off-label for symptomatic adult forms. Corticosteroids, administered topically, orally, or by injection, have also been used to shrink hemangiomas. Sirolimus, an mTOR inhibitor, may be employed for complex or life-threatening cases.
Sclerotherapy involves injecting a solution, such as alcohol or sodium tetradecyl sulfate, directly into the hemangioma to cause it to shrink. This method works by irritating the blood vessel lining, leading to its collapse and eventual absorption. Embolization is another technique where the blood supply to the hemangioma is blocked using catheter-based procedures. This is often used before surgery to reduce bleeding or for lesions that are difficult to remove completely. Laser therapy is effective for superficial skin lesions, targeting the blood pigment to shrink the vessels without damaging surrounding tissue.
Surgical and Other Advanced Treatment Options
When less invasive methods are insufficient, surgical and more advanced treatments may be considered. Surgical excision involves the complete removal of the hemangioma. This approach is indicated for well-localized lesions, those causing significant symptoms or cosmetic issues, or when a definitive diagnosis is needed. Considerations for surgery include the lesion’s location and the potential for bleeding.
Radiofrequency ablation (RFA) and microwave ablation (MWA) use heat to destroy the hemangioma tissue. These techniques are useful for liver hemangiomas and can be performed percutaneously, laparoscopically, or via open surgery. RFA has shown promise for symptomatic hepatic cavernous hemangiomas, with reported success in reducing symptoms and low complication rates. Radiation therapy is a less common treatment due to potential side effects, but it may be used for large, unresectable, or symptomatic lesions in difficult anatomical locations. Cryotherapy, which involves freezing the lesion, is another option, though less commonly applied to deep or large hemangiomas.
Managing Life with an Adult Hemangioma
Living with an adult hemangioma often involves regular follow-up with a specialist. This monitoring helps track any changes in size, appearance, or symptoms. While most adult hemangiomas are benign and manageable, complications can arise, and new symptoms should prompt medical attention.
The prognosis for adult hemangiomas is generally favorable. Some individuals may experience psychological impacts due to the lesion’s appearance. Even after treatment, careful follow-up is necessary to monitor for recurrence or potential side effects related to the intervention.