Surgical outcome in patients treated for hemangioma during infancy, childhood, and adolescence: a retrospective review of 44 consecutive patients.

BACKGROUND: Hemangiomas are the most common tumors in infancy and childhood and account for 7% of benign soft tissue tumors. Diagnosis is usually made in infancy or childhood. There are only a few reports on the surgical treatment of these lesions, likely because the lesions are quite vascular, have a tendency to infiltrate into the muscle and other tissues, and the recurrence rate is quite high.

METHODS: We reviewed the outcome of surgical treatment on 44 consecutive children and adolescents with 47 surgically treated hemangiomas. Hemangiomas involving the face and the head were excluded.

RESULTS: Eleven lesions were surgically treated before the age of 5 years, 20 lesions between the ages of 5 and 12 years, and 16 lesions were treated after the age of 12 years. Eleven lesions had intralesional resection, 33 lesions underwent marginal resection, 2 lesions were managed with wide resection, and 1 lesion underwent radical resection. The overall recurrence rate was 22.2%.

CONCLUSIONS: In the pediatric population, it is desirable to perform definitive treatment whenever possible, thereby minimizing morbidity, both functional and psychological. Asymptomatic lesions should be monitored to confirm the diagnosis and to look for signs of progression. Symptomatic lesions can be treated with surgical excision if this does not result in significant functional impairment. A marginal resection may be used to treat most superficial soft tissue tumors. Intramuscular hemangiomas pose a more difficult therapeutic problem. When the lesion is limited in size, it may be treated with wide local excision. However, if the lesion is more diffusely spread into the muscle unit, the morbidity created by extensive muscle resection has to be weighed against the morbidity of the condition or alternative treatment methods. Whenever possible, a wide marginal resection should be carried out to minimize the risk of recurrence and avoid further surgical procedures. We recommend prolonged follow-up of these patients because 7% of the patients included in this study required late review due to multiple recurrences of these lesions.

LEVEL OF EVIDENCE: Level IV (case series).