Hemangiomas infantis: avaliação e diagnóstico

Abstract

Introduction: Hemangiomas are the most common benign tumors of the vascular endothelium in childhood, often self-limiting. Others can cause complications, such as ulceration, disfigurement, and involvement of vital organs. They can be associated with developmental anomalies. In most cases, their diagnosis is clinical, with history and physical examination. Deeper lesions without characteristic skin changes and liver lesions may be difficult to distinguish from vascular malformations or other tumors. Although imaging studies may be useful, biopsy may be necessary for definitive diagnosis and histopathological evaluation. Objective: To discuss the evaluation and diagnosis of infantile hemangiomas. Methodology: Literature review based on articles from the Scielo, PubMed, and BVS databases, from January to March 2024, with descriptors “infantile hemangiomas”, “evaluation,” and “diagnosis”. Articles from 2019 to 2024 (223 studies) were included. Other categories were removed, with 05 articles in full. Results and Discussion: Vascular lesions should be evaluated regarding the following aspects: age of onset of the lesion and subsequent behavior; results of examinations performed (imaging/biopsies); previous treatments and responses; history of respiratory distress in the first months of life if cervicofacial or mandibular hemangioma; signs of heart failure; telangiectasias/purpura/thrombocytopenia. The physical examination should include skin and mucous membranes, with documentation of morphology, location and size of the lesion; presence and severity of ulceration, bleeding and evidence of secondary infection; hepatomegaly; signs of heart failure (tachycardia, wide pulse pressure). Regarding location: periorbital, segmental (face and scalp, lower body) and multiple). Imaging by ultrasound, tomography or resonance may be an option, but not reliable if there is doubt as to malignancy, in which case a tissue biopsy is indicated. Referral to a specialist in vascular anomalies is essential for the diagnosis and therapeutic management of these children and is more appropriate when associated with other developmental anomalies or segmental lesions. If early, within four to six weeks of life, systemic therapy is considered. Conclusion: Despite its benign nature of the vascular endothelium, hemangioma requires specialist monitoring for its management and prevention of complications in the child's development.