Snapshot A new mom brings her 4-month-old girl to the pediatrician’s office for a new red spot. She noticed a faint red spot around 1 week of age on the left cheek. Since then, it has progressed into a bigger and brighter red birth mark. It does not appear to bother the child. Physical exam reveals a 3-cm bright red and sharply demarcated raised plaque on the left cheek. The pediatrician counsels that these lesions typically resolve spontaneously, but they can consider topical β-blockers. Introduction Clinical definition infantile hemangiomas are benign vascular tumors that occur in infancy also known as strawberry hemangioma login to view 2 more bullets distinct from login to view 5 more bullets Epidemiology Incidence the most common tumor of infancy Demographics females > males Location head and neck Risk factors low birth weight preterm infants multiple gestation babies ETIOLOGY Pathogenesis capillary hemangiomas are benign endothelial neoplasms with two phases the proliferative phase is characterized by rapid growth and increase in the number of endothelial and mast cells login to view 1 more bullet the involutional phase is characterized by regression of the lesion and decrease in the number of mast cells hypoxia may be the initiating factor in the development of hemangiomas Presentation Symptoms appears within the first few weeks of life Physical exam two presentations raised and bright red papule, nodule, or plaque raised and flesh-colored nodule with a blue or dark hue login to view 1 more bullet sharply demarcated typically unilateral commonly on the face and neck Imaging Magnetic resonance imaging (MRI) indications used to delineate the location of the lesion to determine the extent of the hemangioma modality with and without gadolinium Ultrasound of liver indications if patient has 5 or more cutaneous hemangiomas to evaluate for hepatic hemangiomas Studies Biopsy indication if malignancy is suspected or needs to be ruled out Histology proliferation of endothelial cells Making the diagnosis most cases are clinically diagnosed Differential Port-wine stain Pyogenic granuloma Treatment Treatment and management is highly individualized based on the size of lesion, morphology, location, and age Conservative observation indication login to view 1 more bullet Medical β-blockers topical login to view 5 more bullets systemic login to view 6 more bullets corticosteroids topical or intralesional login to view 2 more bullets systemic login to view 2 more bullets Procedural pulsed dye laser indication login to view 1 more bullet Complications Functional impairment if hemangioma occurs on or near eyelids Prognosis Infantile hemangiomas often appear in the first few weeks of life these proliferate for 6-12 months and regress over months to years