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 appears in newborn period spontaneously resolves by 5-8 years old distinct from vascular malformations e.g., port-wine stain cherry hemangioma benign capillary hemangioma in adulthood that does not spontaneously resolve cavernous hemangioma 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 a stimulus for blood vessel proliferation 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 may have central telangiectasias 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 first-line since most lesions will spontaneously resolve Medical β-blockers topical indications small capillary hemangiomas primarily for cosmetic reasons or at the parents’ request drugs topical propranolol or timolol systemic indications larger hemangiomas that are deemed to be at risk for future scarring hemangiomas that can cause functional impairment, such as periocular hemangiomas hemangiomas with ulceration drugs propranolol corticosteroids topical or intralesional indication small capillary hemangiomas that ulcerate systemic indication same as for systemic β-blockers and if β-blockers are contraindicated Procedural pulsed dye laser indication hemangiomas with ulcerations or telangiectasias 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