Some babies are born with or develop shortly after birth red birthmarks or red patches on their faces. These red patches often gradually enlarge as the child grows older, and they usually protrude from the skin surface. In medicine, these red patches are called vascular tumors.
Vascular tumors are congenital benign tumors or vascular malformations, most commonly occurring on the facial skin, subcutaneous tissue, or oral mucosa. These locations account for about 60% of vascular tumors in the body. Some vascular tumors can also invade muscle and bone tissue, and if they occur in the bone marrow cavity, they are called central vascular tumors.
Vascular tumors are generally divided into three types:
(1) Capillary hemangioma is composed of dilated capillaries and mostly occurs on the facial skin, with a few cases occurring on the oral mucosa. This tumor is bright red or purplish red, protruding from the skin, and has a clear demarcation from normal skin. It varies in size and has an irregular shape. When the tumor is pressed with fingers, the skin in the area of the vascular tumor turns white and returns to red when the pressure is released. Vascular tumors enlarge as the baby grows, and among them, there is a type of vascular tumor that protrudes from the skin, with uneven height and a shape resembling a bayberry, called bayberry-like hemangioma.
Capillary hemangioma should be distinguished from vascular nevi. Vascular nevi are skin blood vessel dilations, and because there is red pigment deposition in the skin, the area does not turn white when pressed.
(2) Cavernous hemangioma is composed of many enlarged vascular sinus cavities that are interconnected and filled with venous blood. The size and shape of the vascular sinus cavities vary, and the tumor has a soft texture resembling a sponge, with no clear boundary with the surrounding skin. When pressed, the tumor shrinks due to compression, and it expands again when the pressure is released. When the head is lowered, the vascular tumor noticeably enlarges, and it shrinks back to its original size when the head is raised. Small cavernous hemangiomas generally do not cause symptoms. As the tumor grows, it can affect facial appearance and function. Sometimes, cavernous hemangiomas can grow mixed with capillary hemangiomas, and blood clots can form inside the cavities, which may calcify into venous stones.
(3) Arteriovenous malformation is formed by the anastomosis of small arteries and small veins, with a tortuous and retrograde shape, and it has pulsation. It is located in the subcutaneous tissue and can communicate with deep blood vessels. The boundary is not clear, and when touched, the pulsation of the blood vessels can be felt, and a blowing-like murmur can be heard during auscultation.
Capillary hemangiomas generally do not regress on their own. If they do not grow rapidly, surgery can be performed when the baby is older. If the vascular tumor significantly enlarges, early surgery or partial resection should be considered to reduce its impact on the face.
Smaller cavernous hemangiomas can be surgically removed. If the tumor is larger, especially when it is located in the parotid gland or facial nerve area, complete removal is difficult. In such cases, a sclerosing agent can be injected into the tumor cavity to induce fibrosis and shrinkage of the cavity. Arteriovenous malformations require ligation of the dilated blood vessels to block the blood flow of the vascular tumor before surgical removal.
In recent years, cryotherapy using liquid nitrogen has been used to treat vascular tumors and has shown good results.
