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Getting to know Vascular Anomaly Lesions (1)

What is Vascular Anomaly?

Vascular anomaly is also known as the abnormality of the blood vessel system configuration. The blood vessel system undergoes abnormality or development impairment. It is either the arterial or the venous system, or even the lymphatic system.

Who suffers from it?

Vascular anomalies can be found in newborns, children, or adults. This disease may present as a congenital defect or acquired in all ages of children and adults. Some of the lesions can be hereditary or can also be genetic (changes of gene mutation); however, some also appear sporadically without the proof of a hereditary element.

Do lesions look similar in all patients?

Lesions appear with a wide range of variations. Lesions can appear on the body surface, more commonly in the face area, head, and neck. However, lesions can appear on any parts of the body, including the brain, genitals, upper and lower limbs, as well as other internal areas such as oral, thoracic, and abdominal cavities, which will involve internal organs.

Can lesions be differentiated?

Although it is not easy to differentiate, in general, vascular anomaly lesions can be classified into two groups, which are 1) hemangioma and 2) vascular malformations, without rejecting the possibility that there may be a group of malignant lesions.

Hemangioma is often mistaken for birthmarks. Lesions with blood vessel elements which have presented since birth are usually grouped into vascular malformation ­– faulty blood vessel systems. The word “malformation” refers to the meaning of “abnormally developed” or shortly as “abnormal shape.” This lesion does not grow progressively, but rather grows according to the development of one’s body size. Vascular malformation will not disappear on its own.

Hemangioma, on the other hand, is a lesion that commonly presents several weeks after birth. Lesions may first appear as an insect or mosquito bite, which then grows and widens significantly in a relatively short period of time – weeks to months. Most hemangiomas present as red-colored lesions, similar to strawberries. Hemangioma lesions which do not interfere with children’s functions and development, can stop growing within the first year of age. Therefore, it can be left untreated. Lesions will gradually shrink, leaving a mark as a scar tissue after the age of 5-12 years. During the process of “plateau” and decreasing in size, the color of the lesion will turn into dark red and will continue to fade until it reaches the color similar to the skin. Therefore, hemangioma can be classified as a self-limiting disease that can spontaneously heal, unlike vascular malformations.

Is it true that hemangioma does not need treatment?

In most patients, it is true that hemangiomas do not involve a large area of the body and are far from the possibility of having functional problems in other body parts. Thus, treatments are not needed. Those lesions that are considered safe only need regular observations by doctors. However, the decision to leave the lesions untreated is not always a good decision as we cannot predict how fast the hemangioma can grow and cause functional problems. For example, a small lesion that previously appeared on the cheek not too far from the eyelid which then developed and was diagnosed as a hemangioma. Left untreated, this lesion can spread and reach the eyelid, causing an aesthetic distortion as well as impaired vision. Therefore, hemangioma does need strict observation and the possibility of treatment as soon as possible.

To be continued (2)

Written by Teddy Prasetyono, Ph.D.

Division of Plastic Surgery, Department of Surgery

Dr. Cipto Mangunkusumo Hospital / Faculty of Medicine, Universitas Indonesia

Translated by Illona Andromeda, M.D.


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