The incidence of neonatal hemangioma in China is about 3-8%, which means that at least 300,000 newborns suffer from hemangioma every year, of which primary accounts for 75%. Whether the hemangioma is malignant or benign, it affects the patient’s appearance, however, some of them will damage other organs after deterioration, so how can we distinguish whether the hemangioma is benign or malignant? Domestic hemangioma experts talk about: the growth pattern of hemangioma is mostly lumen expansion, and metastatic hemangioma is extremely rare. Many of what are called malignant metastatic hemangiomas are actually the same hemangioma of multiple origins, rather than metastatic lesions arising from a single primary neoplasm. Malignant tumors with abundant vascularity from other tissue origins are sometimes misdiagnosed as malignant hemangiomas, and truly malignant hemangiomas are quite rare. Parents should beware of 4 kinds of malignant hemangioma 1. hemangioma endothelioma: It is a tumor formed by abnormal proliferation of vascular endothelial cells and belongs to the range of malignant tumors, but its malignancy is not uniform. Some tumors grow slowly and metastases occur late. Endothelioma can occur at any age, and adult cases have a high malignancy rate. If the tumor occurs in the skin, it starts as blue and purplish red spots, and then gradually grows and elevates in the shape of mounds and nodules, and the tumor is mostly round or ovoid, ranging from several millimeters to several centimeters in diameter. Soft texture, unclear boundary, no obvious envelope, sometimes satellite nodules are seen around the tumor, rich and fragile blood vessels inside the tumor, easy to bleed spontaneously, and the hemangioendothelioma growing in the skin and subcutaneous often forms ulcers and combined bleeding. Most of them grow in superficial soft tissues, but can appear in any part of the body, such as nose, meninges, scalp, neck, retroperitoneal space, tongue, pericardium, diaphragm, ileum, tissues, etc. The tumor has clear edges, generally has a pericardium, is confined nodular, and varies in size. The color of hemangiosarcoma is not red, so when this lesion is first encountered, it is often not thought of as a tumor of vascular origin. 3.Hemangiosarcoma: It is a malignant tumor occurring from vascular endothelial cells or mesenchymal cells differentiated towards vascular endothelial cells, which is less common. The preferred sites are the skin of the head and face, breast, deep thigh muscles, followed by the skin of the retroperitoneum, trunk and extremities. This tumor has a high degree of malignancy and can often metastasize to liver, lung and bone via blood circulation at an early stage, and to lymph nodes in the drainage area via lymph. 4.Vascular smooth muscle sarcoma: generally ovoid, lobulated, grayish-yellow or white mass, moderately hard, generally 4-5 cm in diameter, tumor is not peritoneal. Identification: Most of the endothelium of the involved vessels is intact, and the dissection is a yellowish-white irregularly sized nodule with sporadic small pieces of hemorrhage and occasional central necrotic areas. The parents of malignant hemangioma should not panic, experts advocate scientific “targeted” treatment. Experts say: clinically, there are many kinds of hemangioma, as each hemangioma has its own characteristics. For example, capillary hemangioma grows superficially, cavernous hemangioma damages deeper, while mixed hemangioma is more complicated, it is a mixture of two or more different types of hemangioma, the lesions are deep and shallow, when treatment should not only consider the treatment of superficial hemangioma, but also do not consider whether there is damage to the deep subcutaneous tissue. Therefore, when choosing the treatment plan, we should consider different aspects, such as the type of hemangioma, the growth site, the patient’s age, and the degree of damage.