Hemangioma

by Robyn Ndikumana MD BScN and Allison Osmond, MD FRCPC
October 24, 2022

What is a hemangioma? 

A hemangioma is a non-cancerous tumour made from abnormal blood vessels. Without a microscope, the tumour looks red to blue in colour, and there tends to be a clear border between the tumour and the surrounding normal tissue.

Where are hemangiomas commonly found?

This kind of tumour can start anywhere on the body, although they are most commonly found in the skin, head and neck, and liver. These tumours range in size from very small (1-2 millimetres) to very large (over 20 centimetres).

At what age does a hemangioma develop?

Hemangiomas can develop at any age. A tumour that is present at birth is called a congenital hemangioma. In contrast, a tumour that develops in the first few days or weeks after birth is called an infantile hemangioma. Other types of hemangiomas develop later in life.

What are the types of hemangiomas?

There are many different kinds of hemangiomas. The type of hemangioma depends on when the tumour developed, where the tumour is located on the body, and the types of blood vessels found inside the tumour. Common types of hemangiomas include capillary, cavernous, congenital, epithelioid, targetoid, infantile, lobular capillary, verrucous, and infiltrating. All types of hemangiomas are non-cancerous. Some types are likely to disappear on their own while other types may have to be removed surgically.

Capillary hemangioma

A capillary hemangioma is a very common type of hemangioma. It is also called “strawberry hemangioma” because it has a red colour. It commonly starts in the skin and may slowly disappear over time.

Cavernous hemangioma

A cavernous hemangioma can be found in places like the liver, brain, and eye. Unlike other types of hemangiomas, it does not regress over time.

Congenital hemangioma

Congenital hemangioma is one that is present at birth.

Epithelioid hemangioma

An epithelioid hemangioma is commonly found in the head and neck area. Another name for this type of hemangioma is angiolymphoid hyperplasia with eosinophils. It can sometimes develop after an injury to the skin. When viewed under the microscope, lots of specialized immune cells called eosinophils are seen inside the tumour.

Targetoid hemangioma

A targetoid hemangioma is also called a hobnail hemangioma. It often has a bright red or blue centre with a pale or dark rim which looks like a ‘target’.

Infantile hemangioma

An infantile hemangioma develops in the first few days or weeks after birth. It can regress over time.

Lobular capillary hemangioma

Lobular capillary hemangiomas can grow very fast and can be initially confused for cancer. Some tumours develop after an injury and they are more common in women who are pregnant. Historically this type of tumour was called a pyogenic granuloma also that name is misleading because it is neither ‘pyogenic’ nor ‘granulomatous’.

Verrucous hemangioma

Most verrucous hemangiomas develop shortly after birth and can look like a bump or ‘wart’ on the skin.

Infiltrating hemangioma

Unlike other types of hemangiomas, there is no clear border between an infiltrating hemangioma and the normal surrounding normal tissue. As a result, it can be difficult for your doctor to completely remove the tumour.

How is this diagnosis made?

This diagnosis can be made when a small sample of the tumour is removed in a procedure called a biopsy. The diagnosis can also be made when the entire tumour is removed and sent to a pathologist for examination under a microscope.

What does tumour regression mean?

Some types of hemangiomas can decrease in size or even disappear on their own over time. This type of change is called regression and it is more commonly seen in infantile hemangiomas.  Tumours that do not disappear on their own can be surgically removed. Some medications are also available to help shrink the tumour.