The common tumor pathology types of pediatric cephalofacial hemangioma are capillary hemangioma, cavernous hemangioma and trabecular hemangioma, which are fast-growing, disfiguring, difficult to operate and prone to recurrence after surgery, and difficult to treat clinically. 90 cases of pediatric cephalofacial hemangioma were treated with pinyamycin, with good curative effect and no recurrence in the long term. This paper also discusses the response of different types of hemangioma to Pingyangmycin treatment. Pediatric hemangioma is a congenital vascular malformation with the histological characteristics of a general tumor. Although a small proportion of pediatric hemangiomas can sometimes subside due to vascular embolization, hemangiomas born on the head and face may seriously affect aesthetics, and thus, pediatric hemangiomas on the head and face also require early and aggressive treatment. There are many methods to treat pediatric hemangioma on the body surface, but for larger hemangioma on the face, surgical treatment was mostly used in the past, but surgical treatment is difficult, sometimes it cannot be removed cleanly and causes surgical disfigurement. Since July 2006, our hospital has been instructed to apply Pingyangmycin tumor injection to treat 90 cases of pediatric head and facial hemangioma according to the pathological type, and the treatment response of different types has been analyzed. The treatment situation is summarized as follows. 1. Clinical data 1.1 Site of hemangioma and pathological type There were 90 cases in this group, 60 males and 30 females, aged 1 month-8 years. Lesion sites: 58 cases on the face, 8 cases on the tongue, 5 cases on the lips and cheeks, 5 cases on the parotid gland, 2 cases on the eyes and 2 cases on the neck. Among them, 45 cases of capillary hemangioma were shaped like prunes and 30 cases of cavernous hemangioma were diagnosed as cavernous hemangioma because coagulated blood could be extracted by puncture. There were 15 cases of trapezius hemangioma, which occurred between the eyebrows and scalp, with tortuous and angry surface vessels, and mostly combined with arteriovenous malformation. 1.2 Application method Pingyangmycin (from Tianjin Hebei Pharmaceutical Factory) was used at 0.2-0.3mg. kg-1 per dose, dissolved in water for injection, and the concentration was kept at 1-2mg. ml-1, with each dose not exceeding 8mg. Larger cavernous hemangiomas should be combined with other sclerosing agents or used alternately. If the tumor does not subside in one treatment, repeat the treatment after 20 days until the tumor disappears; for small area hemangioma, inject the drug until the surface of the tumor becomes pale. After injection, the tumor body should be lightly rubbed to make the drug evenly distributed in the tumor body, and the needle hole should be pressed for 2–3 minutes to prevent the drug from flowing out and bleeding. Local swelling for 2–3 days after local injection need not be treated. Different doses of prednisone were given orally according to the patient’s age. 1.3 Criteria for judging the efficacy and treatment effect ①Cure: the tumor disappeared completely after treatment, and the local skin mucosa morphology was normal; ②Basic cure: the tumor disappeared basically, and the local skin mucosa was close to normal skin or had mild pigmentation and mild fibrosis; ③Improve: the tumor shrank significantly but did not disappear completely, and local scar remained; ④Invalid: the tumor did not change significantly or increased compared with before. In this paper, 70 cases were cured, 11 cases were basically cured, 6 cases were improved, and 3 cases were invalid. 2. Discussion 2.1 Mechanism of action Traditional sclerosing agents such as anhydrous alcohol, urea, sodium cod liver oil acid, etc. are used to treat hemangioma by producing sterile chemical inflammation and proliferation of fibrous tissue to occlude the lumen of hemangioma and achieve therapeutic purpose, with slow onset and poor efficacy. Pingyangmycin, a class of bleomycin produced by Streptomyces pingyangensis, is a new type of antitumor antibiotic that is gaining more and more attention in the local treatment of pediatric hemangioma, and is more suitable for pediatric application because of its low toxicity and low impact on the immune function and hematopoietic system of the body. Its mechanism of action is mainly to inhibit cellular DNA synthesis and generate free radicals in the process of DNA degradation, which can damage endothelial cells and inhibit their growth through the action of free radicals on cells in hemangioma, and destroy the integrity of blood vessel wall, causing extravasation of plasma components in blood vessels, tissue edema, degeneration and hyperplasia, which can lead to sterile inflammatory reaction and eventually vasoconstriction and thickening of blood vessel wall, and finally lead to vascular occlusion. The hemangioma stops growing and gradually fades away, thus achieving the purpose of treating hemangioma. It has the dual effect of inhibiting the growth of endothelial cells of hemangioma and causing interstitial fibrosis as a chemical stimulant, while the ratio of chemotherapy effect is much larger, thus, it has a fast onset and good efficacy. From the histological point of view, Pingyangmycin has poor effect on the types with more mesenchymal stroma and better effect on the types with less mesenchymal stroma. From the viewpoint of hemangioma pathological types, trapezius hemangioma with the largest vascular lumen and the least interstitial mass has the best efficacy, cavernous hemangioma is the second, and capillary hemangioma with the smallest lumen and the most interstitial mass has poorer efficacy than other types, which is consistent with the literature (2,3). 2.2 Precautions Hemangiomas vary in size and depth, age and weight differences, and Pingyangmycin dosage. However, because the dosage of drug used for local injection therapy is limited, it is not easy to grasp the dosage for hemangioma with too large an area. Generally, we should control the dosage and total amount each time according to the area of tumor and the weight of children, and no obvious side effects have been observed. We appreciate that we should also avoid multiple repetitions at a fixed site, otherwise it will cause tissue ischemic necrosis Different types of hemangioma are treated differently, and the efficacy is not the same. The general efficacy of capillary hemangioma is better, reaching 95.2% in our group. It is generally believed that the necrosis at the injection site is proportional to the drug dose and inversely proportional to its injection depth. For the treatment of capillary hemangioma, a small needle should be used to pierce into the hemangioma under aseptic operation, and the needle should not be too deep and overdosed with drugs to prevent local skin necrosis. The volume of necrosis caused by the same amount of Pingyangmycin injection is larger in larger children, and this should be noted. The purpose of treatment for spongiform hemangioma or mixed hemangioma is different from that of the former, which is to harden and absorb the hemangioma tissue rather than to cause necrosis. For relatively large tumor volume, multi-point injection should be used, but the amount of drugs used each time should not be too much to avoid increasing adverse reactions. In our experience, one injection at intervals of 1 week to 2 weeks is generally appropriate. In short, we should wait until the local swelling of the hemangioma has completely subsided and the sclerosis or necrosis has reached its peak before the second injection is appropriate, and we should not be too hasty.