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Review Question - QID 104264

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QID 104264 (Type "104264" in App Search)
A 6-month-old boy is brought in by his mother who is concerned about a raised red lesion on his scalp (Figure A). The mother reports that she first noted it at birth, and that it has increased in size over the past two months. The patient was born from a full-term pregnancy with no complications and an unremarkable vaginal delivery. He has no medical problems and takes no medications except for Vitamin D. He breast feeds and his mother supplements with formula. His vital signs are stable and his physical examination is unremarkable with the exception of the lesion in question. What is the appropriate next step in management?
  • A

Mohs surgery

3%

3/91

Laser therapy

1%

1/91

Excisional biopsy

4%

4/91

Observation

88%

80/91

Cryotherapy

2%

2/91

  • A

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Strawberry hemangiomas are the most common benign vascular tumor in children. They appear shortly after birth, grow rapidly, and generally recede by 5-8 years of age without treatment.

Strawberry hemangiomas (also known as capillary hemangiomas) are vascular birth marks that develop at, or shortly after birth. They are more common in females and on the neck and face, and they almost always resolve on their own. Laser therapy or surgical removal are not required or recommended but may be done in the case of unresolving lesions to improve cosmesis, or in cases of visual or airway obstruction. A similarly appearing cousin of the strawberry hemangioma is the cherry hemangiomas, a benign vascular tumor found in the elderly that does not regress.

McLaughlin et al. discuss birthmarks in the newborn. Birthmarks in newborns are common sources of parental concern. Although large congenital melanocytic nevi require evaluation for removal, whereas smaller nevi may be observed for malignant changes. With few exceptions, benign birthmarks (e.g., dermal melanosis, hemangioma of infancy, port-wine stain, nevus simplex) do not require treatment; however, effective cosmetic laser treatments exist.

Lee and Bercovitch discuss infantile hemangiomas. Infantile hemangiomas are the most common tumors of infancy. The serendipitous discovery of the therapeutic efficacy of propranolol in the management of infantile hemangiomas has revolutionized the care and understanding of these lesions, and greatly improved the prognosis for a good cosmetic outcome. Treatment is always indicated in those hemangiomas that cause airway compromise or amblyopia.

Image A depicts a strawberry hemangioma. Illustration A depicts a cherry hemangioma.

Incorrect Answers:
Answer 1: Mohs surgery would be indicated for a neoplastic growth such as a basal cell carcinoma.
Answer 2: Laser therapy will just result in a scar and this lesion should recede on its own without treatment.
Answer 3: Excisional biopsy is indicated for lesions such as melanoma.
Answer 5: Cryotherapy can be used to remove warts but this lesion will regress on its own without treatment.

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