Deep (Cavernous) Hemangioma

A 3-month-old boy was initially evaluated for a skin-colored, 1 × 3-cm, diffuse swelling in the right superior orbit area. The lesion had been slowly growing for a month and was asymptomatic. He was referred to a pediatric ophthalmologist who administered 2 corticosteroid injections intralesionally.

At follow-up 5 months later, the lesion had enlarged to the size shown, about 2 × 4 cm. It was hypopigmented and had an area of indentation (0.5 × 1 cm) on the lateral aspect. The hypopigmentation and lateral atrophic area were secondary to the corticosteroid injections. The lesion could be completely flattened with finger compression.

Robert P. Blereau, MD, of Morgan City, La, writes that deep (cavernous) hemangiomas are present at birth but may not manifest--as in this case--until the child is several weeks or months old. These dilated blood vessels deep in the dermis and subcutaneous tissue appear pale, skin-colored or red or blue, and round or oblong. They are fully compressible and asymptomatic. Diagnosis is established by the gross appearance and their compressibility.

The life cycle of a deep (cavernous) hemangioma is the same as that of a superficial hemangioma. Most proliferate for the first year or two, then regress with fibrosis for the next several years. Following regression, most hemangiomas appear as virtually normal skin; some resolve with scarring, atrophy, telangiectasia, or pigmentation change.

Facial lesions and those that produce functional impairment may require active intervention. Treatment options include oral or intralesional corticosteroid injections, interferon alfa 2b, laser therapy, topical imiquimod, and surgery.

This patient underwent ophthalmic plastic and reconstructive surgery with excellent cosmetic results.