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The classification of vascular tumours can seem complicated, but it is important since prognoses differ, and some types are systemic, with internal organ involvement ( Box 67.1 ).
Infantile haemangioma
Congenital haemangioma
Rapidly involuting
Non-involuting
Rare forms, e.g. tufted angioma
Capillary (slow flow)
Venous (slow flow)
Lymphatic (slow flow)
Arteriovenous (fast flow)
Combined: capillary, venous, arterial, lymphatic (slow and/or fast flow)
Infantile haemangiomas are the most common childhood tumour, affecting about 10% of infants at 1 year, with a neonatal prevalence of 1%–3%. They show a threefold female preponderance. Infantile haemangiomas are benign endothelial proliferations, often found on the head or neck ( Fig. 67.1 ). Typically they grow over the first months of life, then slowly involute usually regressing by 5–7 years, leaving atrophy, unlike most vascular malformations that do not ( Fig. 67.2 ).
Infantile haemangiomas include what were previously called capillary haemangioma and strawberry naevus. About a half are superficial, 15% deep and a third ‘mixed’ ( Fig. 67.3 ). They are multiple in a quarter of cases. When segmental, extracutaneous anomalies are possible.
Congenital haemangiomas reach maximum size at birth, do not show a postnatal growth phase and are either rapidly involuting or non-involuting in type. The rapidly involuting form is a bluish–purple plaque or tumour with telangiectasia. The non-involuting type is round or ovoid, and pink-purple in colour with central pallor. Both forms occur on the head, limb or near a joint.
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