Vascular Malformations

Vascular lesions are abnormalities of vascular elements that appear at birth or in infancy. Studies of the cellular features of cutaneous vascular lesions have identified two general types:

  • Hemangiomas
  • Vascular Malformations

Hemangiomas are vascular tumors that grow by cellular proliferation. Vascular malformations are tumors created by errors in morphogenesis or cell type.

The vascular lesion team consists of a dermatologists, radiologists, and surgeons experienced in the evaluation, imaging, diagnosis, medical and surgical treatment of these conditions. When vascular lesions are extensive or they involve delicate features of the face, surgical treatment by a skilled pediatric craniofacial plastic surgeon can assure a more optimal outcome.


Hemangiomas are the most common benign tumor in infancy, occurring in 1% to 2% of all newborns. Hemangiomas are generally not recognized until they begin to grow after several weeks or months of life. Most occur as a single lesion and most occur on the head (60%).

A hemangioma is made up of endothelial cells, the kind that forms the lining of blood vessels. If close to the skin surface it will appear raised and crimson, like a strawberry or raspberry. If deep to the surface the skin may be smooth with a bluish hue.

Hemangiomas undergo a phase of proliferation or rapid growth until the child is 6 to 10 months old, and then they slowly involute or disappear. By age 5 to 7 years there may be little sign of the original growth in many children, and in other children a fibrofatty mass with pale and wrinkled skin may be left.

Critical structures that may be involved include:

  • Orbit
  • Eyelids
  • Ear Canal
  • Mouth
  • Airway

Complications such as ulceration, bleeding, disfigurement, and interference with vision, hearing, eating or breathing require active treatment. In these complex cases, steroid treatment, beta blockers, laser surgery, or reconstructive surgery may be needed.

Vascular Malformations

Vascular Malformations are diffuse lesions consisting of abnormal vessels which are present at birth, and which grow in proportion to the child’s growth.

Vascular malformations are classified by the type of vessel involved:

  • Capillary
  • Venous
  • Lymphatic
  • Arterial

Capillary, venous and lymphatic malformations are often mixtures of 2 or 3 of these vessel types, and there is a low flow rate through these vessels. Capillary malformations may present as port-wine colored stains. Venous malformations are soft, compressible, non-pulsatile spongy masses that may be localized or extensive. The overlying skin may be blue if the dermis is involved

A lymphatic malformation is a mass in the head or neck that results from an abnormal formation of lymphatic vessels. Lymphatic vessels are small canals that lie near blood vessels and help carry tissue fluids from within the body to the lymph nodes and back to the bloodstream.

There are two main types of lymphatic malformations:

  • lymphangioma – a group of lymphatic vessels that form a mass or lump. A cavernous lymphangioma contains greatly enlarged lymphatic vessels.
  • cystic hygroma – a large cyst or pocket of lymphatic fluid that results from blocked lymphatic vessels. A cystic hygroma may contain multiple cysts connected to each other by the lymphatic vessels.

Nearly all cystic hygromas occur in the neck, although some lymphangiomas can occur in the mouth, cheek, and tissues surrounding the ear, as well as other parts of the body. Over half of lymphatic malformations are congenital (present at birth), and most are detected by age 2. Some lymphatic malformations can spread into surrounding tissues and affect the proper development of the area. Lymphatic malformations may also enlarge and become infected following an upper respiratory infection.

Lymphatic malformations are sometimes seen in children with certain chromosome abnormalities and genetic conditions, including Down syndrome and Turner syndrome.

Although vascular malformations are generally stable over time, it is important to receive an early evaluation to avoid complications with vital structures and bleeding.


Arterial malformations often have a venous component, and there is a high flow rate through these medium-sized arteries and veins. These lesions are pulsatile and the turbulence of blood flowing through them can be felt (thrill) or heard (bruit). They occur most frequently in the head and their high flow causes the overlying skin to be warm.

Diagnosis and treatment of vascular malformations can be difficult sometimes requiring extensive evaluation by a vascular lesion team. CT and MRI studies are often necessary to identify the extent of a lesion and its flow pattern. An evaluation by the pediatric dermatologist, vascular radiologist and pediatric craniofacial plastic surgeon will help assure an accurate diagnosis, a complete treatment plan and an optimal cosmetic outcome. Multifaceted approaches are often employed using interventional radiology to sclerose these malformations with various infusion agents that help shrink the lesion by obliterating the blood flow.  Surgery is also employed to help debulk or remove these lesions that may continue  to grow throughout one’s life.  Laser treatments are often used to collapse the vascular lesions and soften the dark coloring.