Excisional surgery always leaves some degree of permanent scarring, and this needs to be considered in deciding whether to operate. Excisional surgery may be necessary after a hemangioma has largely resolved if there is permanent distortion or significant scar. Previously some hemangiomas needed surgery even earlier in life, however now with better medical treatment, surgery can often be avoided. Reasons to treat with surgery include:
- Hemangiomas which are ulcerated and painful and not responding to wound care and medical therapy.
- Hemangiomas which are mushroom-like or thick and sticking out above the normal skin may need surgical correction eventually, so early surgery may be considered, especially if they are not responding to medical therapy.
- Involuted or nearly involuted hemangiomas which are leaving distortion of the skin or scarring. We like to operate on these children after age 3 but ideally before age 5 when children have increased body awareness and start elementary school.
Left ear: This child’s earlobe hemangioma was treated with two surgeries at ages 10 months and 2 years. (Images courtesy of Dr. June Wu)
Right cheek: This child’s large hemangioma on her cheek that was previously ulcerated was treated with two surgeries at ages 2 and 3 years.
Nasal tip: This child’s nasal tip hemangioma was treated with two surgeries at ages 15 months and 3 years.
Lip: This child’s lip hemangioma was treated with steroids and surgeries at ages 1 and 2 years.