Hemangioma is the most common type of vascular malformation, also known as a birthmark. It is a benign tumor that originates from residual embryonic angiogenic cells. It is most common at birth or shortly after birth, and 60% to 70% of hemangiomas may resolve by the age of 8. Some hemangiomas continue to grow and spread rapidly, resulting in changes in appearance and dysfunction, causing psychological disorders and inconvenience in daily life. Are hemangiomas common? Hemangioma is the most common benign tumor in infants, with an incidence of about 4-10%, and is usually more common in girls, about 3-5 times that of boys. They occur more frequently in whites than in yellows, and are less common in blacks. The incidence of premature low birth weight (less than 1 kg at birth) is as high as 25%, while the incidence of twins is also higher. What causes hemangiomas? Although 10% of infants who develop hemangioma have a family history, it is not a genetic disease. There is no definite food or drug that can cause hemangioma, and there is no association with maternal behavior during pregnancy. Current research suggests that there may be a relationship with genetic mutations that occur during the transition from progenitor cells to endothelial cells within the fetus. When do hemangiomas appear? Hemangiomas can be detected at birth in about 1/3 of children. The average time of appearance of hemangiomas is usually when the infant is two weeks old, and deeper hemangiomas may not be detected until 3 to 4 months of age. Adults rarely develop hemangiomas. Where do hemangiomas tend to occur? About 60% of hemangiomas occur in the head and neck, about 25% in the trunk, and about 15% in the extremities. The vast majority (about 80%) of hemangiomas occur in a single location, and a few can occur in multiple locations. Although most hemangiomas occur on the surface of the body, a small percentage can occur in the liver, gastrointestinal tract, or even in the brain. What does a hemangioma look like? The appearance of a hemangioma depends on many factors, including whether it is superficial or deep, whether it is proliferating, stable or fading, and whether it is found at birth or after birth. At the same time, subcutaneous veins can be seen in a radial pattern along the tumor. As the hemangioma fades, its color slowly becomes lighter, usually fading by the time the child reaches 7 years of age. Hemangiomas under the skin are called deep hemangiomas and appear as a bruise or light blue color, some of which are not visible at all. This type of hemangioma is usually not detected until the baby is 2-4 months old. When parents see these pictures, they must know that each case is unique and not all hemangiomas that look the same as their child’s appearance will change the same later. Is it possible to prevent hemangiomas from occurring? There is no way that we know of to prevent it. Nothing the mother does before or during pregnancy has anything to do with the development of hemangioma. When should I consult a hemangioma specialist? Although most hemangiomas are relatively small and can resolve without any treatment, it is important to consult a hemangioma specialist who can give parents expert advice and can determine the future direction of the hemangioma at follow-up visits. It is important to bring your child to a doctor if the diagnosis is unclear, if the hemangioma is large, if it is growing rapidly, or if the hemangioma is complicated by other symptoms. If a child has multiple hemangiomas, it is important to see a doctor because it is necessary to rule out the presence of hemangiomas in internal organs, including the liver and digestive tract. Because hemangiomas in these areas are more dangerous if they appear, they need to be treated. What are the complications of hemangioma? Complications of hemangioma include ulcers (skin breakdown) leading to bleeding or infection, damage to vital organ function, disfigurement, and, more rarely, heart failure. Ulceration usually occurs in 5-10% of hemangiomas, especially around the lips, anus or genitals. Local debridement and antibiotics are effective in treating the ulcers, and if bleeding is present, pressure can be applied to the wound to stop the bleeding. Ulcers usually heal within a few weeks and do not recur. However, some may leave scars. If a hemangioma affects your breathing, hearing, vision or diet, you need to see a doctor right away. How are hemangiomas diagnosed? Most hemangiomas can be diagnosed by physical examination and medical history. Sometimes they need to be differentiated from vascular malformations, including venous malformations and lymphatic malformations, which are treated by different methods. If a mass cannot be diagnosed as a hemangioma or a vascular malformation, color Doppler ultrasonography can be performed to differentiate. CT or MRI can also be performed if necessary. If malignancy is suspected, a puncture biopsy, which is an invasive test, may be required. What is the treatment for hemangioma? Most hemangiomas do not require treatment other than observation, as they resolve on their own, and most resolve completely, although some may leave scars or slight changes in skin color. Some may leave scars or slight changes in skin color. If this occurs, we can treat it with laser or plastic surgery before the child goes to school. Hemangiomas must be treated when: 1) they are growing rapidly; 2) they are large with bleeding, infection and ulcers; 3) they endanger vital functions such as eating, breathing, swallowing, hearing or vision, excretion or motor functions; 4) they are associated with thrombocytopenia syndrome (Kasabach-Merritt syndrome); 5) they are associated with high output heart failure; (6) lesions invading important facial structures such as eyelids, nose, lips, human middle, earwalls, etc. Treatment methods include drug therapy, surgery or interventional therapy. Medications include corticosteroids, vincristine, or interferon; surgical excision can be performed when the hemangioma grows on the upper eyelid or obstructs the airway. However, surgical excision can cause scarring. Interventional embolization of large hemangiomas to block blood flow is currently a good treatment option. Other treatment options include laser and nucleoplasty. The overall principle of treatment is to provide individualized, minimally invasive, and effective treatment for the child.