We often wait until age 3 or 4 years to decide whether to surgically remove a hemangioma because by then we can usually tell whether there will be permanent skin distortion or scar, but in some cases surgery may be indicated much earlier. Excisional surgery always leaves some degree of permanent scarring, and this needs to be considered in deciding whether to operate. Reasons to treat with surgery include:
- Hemangiomas which are ulcerated and painful and not responding to wound care.
- Hemangiomas which are mushroom-like or thick and sticking out above the normal skin often need surgical correction eventually, so early surgery may be considered.
- Involuted or nearly involuted hemangiomas which are leaving distortion of the skin or scarring. As mentioned, 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. (Images courtesy of Drs. Kimberly Morel and June Wu)
Nasal tip: This child’s nasal tip hemangioma was treated with two surgeries at ages 15 months and 3 years. (Images courtesy of Dr. June Wu)
Lip: This child’s lip hemangioma was treated with steroids and surgeries at ages 1 and 2 years. (Images courtesy of Drs. Kimberly Morel and June Wu)