Review Question - QID 214392

This 6-month-old boy has findings most consistent with a strawberry hemangioma (rapidly growing, well-defined, bright red, dome-shaped, vascular papule). Strawberry hemangiomas most often spontaneously regress; therefore, patients and parents should be reassured that no treatment is necessary.

Strawberry hemangiomas are benign vascular tumors most often found in infants and young children. They can occur anywhere on the body but most commonly appear on the scalp, face, chest, or back. They usually first appear on infants that are 4-6 weeks old and may grow rapidly for up to a few months before shrinking or involuting. Given that the vast majority of lesions spontaneously regress, treatment is usually unnecessary. However, occasionally strawberry hemangiomas can interfere with vision or breathing, in which case treatment is required. Pharmacotherapy (e.g., beta blockers and corticosteroids) is first-line therapy, followed by laser surgery or debulking if necessary.

Figure A demonstrates a strawberry hemangioma located on the scalp. The lesion is a well-defined, bright red, dome-shaped, vascular papule.

Incorrect Answers:
Answers 1 & 4: Beta blockers and steroid injections are first-line therapy for strawberry hemangiomas that interfere with vision or breathing. Beta blockers are thought to inhibit tumor growth by vasoconstriction, inhibition of angiogenesis, and induction of apoptosis of capillary endothelial cells. Steroids are thought to have an inhibitory effect on the production of vascular endothelial growth factor A (VEGF-A) by stem cells in hemangiomas. This patient's lesion is located on the scalp and therefore conservative therapy is more appropriate.

Answer 2: Cryotherapy is useful in the management of small benign skin lesions such as actinic keratoses and verruca vulgaris (warts). Cryotherapy is not used in the management of strawberry hemangiomas.

Answer 5: Surgical excision is used for the treatment of malignant skin lesions. Strawberry hemangiomas are benign and spontaneously regress; therefore, surgical excision would not be the appropriate choice of management.

Bullet Summary:
Strawberry hemangiomas are benign vascular skin lesions that most often spontaneously regress without treatment.