Haemangiomas

A haemangioma is a benign growth made of blood vessels. They can appear anywhere on the body, ranging from a small red dot to a large lesion involving a wide area and extending beneath the skin. Colour varies from bright red to deep purple depending on how deep the vessels sit.

Some are present at birth or appear in the first weeks of life; others develop later.

The types, and why the distinction matters

Infantile haemangioma (strawberry mark)

Appears in the first weeks of life, grows for several months, then involutes slowly over years. Most need no treatment at all - the natural history is resolution, and intervening on one that would have resolved is over-treatment.

Some do need early specialist assessment: those near the eye (which can affect vision development), near the airway, on the nose or lip, those that are very large, those ulcerating, and multiple lesions. That is paediatric territory, and we will refer rather than treat.

Congenital haemangioma

Fully formed at birth. Some resolve rapidly; some do not change at all.

Cherry angioma (Campbell de Morgan spot)

Small bright red domed spots that appear in adulthood and increase in number with age. Extremely common, entirely benign, and the type most adults are asking about. They do not resolve on their own.

Vascular malformations

Including port wine stains. These are not tumours - they are abnormally formed vessels present from birth that grow with the person and do not involute. They behave quite differently from haemangiomas and are treated differently. See birthmarks.

Assessment first

A lesion is examined before treatment. The reasons:

Infantile haemangiomas that will resolve on their own should generally be left alone
Certain sites and presentations need paediatric or specialist referral rather than cosmetic treatment
Vascular malformations need a different approach from haemangiomas
A few pigmented and vascular lesions can be confused with each other, and some with more serious lesions - an amelanotic melanoma or a pyogenic granuloma can look like a vascular lump

Where there is doubt about what a lesion is, it is excised whole and sent to pathology rather than destroyed with laser. See skin cancers.

Have a lesion checked promptly if it bleeds repeatedly, ulcerates, grows quickly in an adult, or changes in colour or texture.

Treatment

Vascular laser

Nd:YAG and other vascular wavelengths are absorbed by haemoglobin, heating and closing the vessels. This is the usual treatment for cherry angiomas, small superficial haemangiomas and residual redness. Cherry angiomas often clear in one or two sessions.

IPL

Suits flatter, more diffuse vascular lesions.

Radiofrequency (electrosurgery)

For small raised vascular lesions. See electrosurgery.

Surgical excision

For larger or deeper lesions, or where a diagnosis is needed. Leaves a scar.

Observation

A legitimate plan, and the right one for most infantile haemangiomas and for any benign lesion that is not bothering you.

See laser treatments.

What to expect

Laser sessions are short - often minutes for a few small lesions. Expect redness and swelling for a day or two; treated lesions commonly darken or form a small crust before clearing over one to three weeks. Do not pick the crust.

Protect the area from sun while it heals, then use sunscreen.

What results are realistic

Cherry angiomas and small superficial haemangiomas usually clear well. Deeper lesions respond partially - the surface component lightens while the deeper part remains. Larger lesions may need several sessions and may still leave a visible mark or slight texture change.

New cherry angiomas continue to appear with age; treatment does not prevent that. Individual results vary with lesion type, size and depth, and with skin type.

Risks

Redness, swelling and bruising after treatment
Blistering and crusting
Changes in pigmentation, lighter or darker, which can persist - more likely in darker skin types
Scarring, including a small depressed or textural mark at the site
Bleeding
Infection
Incomplete clearance, particularly of deeper lesions
Recurrence of the lesion, and new lesions elsewhere
Pain during treatment

See risks and complications.

Cost

As at September 2024 and including GST, a skin assessment is $50 and a Cosmetic Doctor consultation is $150. Cost depends on the number, size and depth of lesions and is quoted after assessment. Cosmetic treatment is not covered by Medicare; medically indicated treatment may attract a rebate.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.