Congenital Hemangioma

Congenital hemangiomas are vascular anomalies present at birth, distinct from infantile hemangiomas which appear later. Understanding these birthmarks is crucial for proper diagnosis and management.

Massive Bio

30 November 2025

Key Takeaways

Congenital hemangiomas are fully formed vascular tumors present at birth.
They are categorized into Rapidly Involuting (RICH), Non-Involuting (NICH), and Partially Involuting (PICH) types.
Symptoms include a visible reddish-purple lesion, often warm to the touch, with varying textures.
Diagnosis relies on clinical appearance; treatment depends on the specific type, size, and location.
Management ranges from observation for RICH to surgical removal or embolization for NICH.

What is Congenital Hemangioma?

A congenital hemangioma is a benign vascular tumor fully developed at birth, distinguishing it from infantile hemangiomas that emerge weeks after birth. These lesions form during fetal development, appearing as a solitary, well-circumscribed mass. Understanding what is congenital hemangioma involves recognizing its unique characteristics, including its presence at birth and distinct natural history. Affecting less than 1% of newborns, their exact cause is unknown but is thought to involve errors in vascular development during gestation, leading to an abnormal collection of blood vessels.

There are distinct types of congenital hemangioma, primarily classified by their natural history after birth:

Rapidly Involuting Congenital Hemangioma (RICH): These lesions undergo rapid regression within the first 12-18 months of life, often leaving residual skin changes like atrophy or redundant skin.
Non-Involuting Congenital Hemangioma (NICH): Unlike RICH, NICH lesions do not involute. They persist throughout life, growing proportionally with the child without regression.
Partially Involuting Congenital Hemangioma (PICH): This less common type shows some involution but leaves a persistent residual component.

Recognizing Symptoms of Congenital Hemangioma

The presence of congenital hemangioma symptoms is immediate at birth, making them clearly distinguishable from other vascular lesions. The primary symptom is a visible lesion, which can vary in appearance, size, and location:

Appearance: Typically a solitary, well-defined mass or plaque. Colors range from pinkish-red to deep purple or blue, often with a central pallor or surrounding halo. The surface may be smooth, lobulated, or, in some cases, ulcerated.
Temperature: Often warmer to the touch than surrounding skin due to increased blood flow within the vascular malformation.
Texture: Can feel soft or firm, depending on the depth and type of the hemangioma.
Location: While they can appear anywhere on the body, common sites include the head and neck, trunk, and extremities.
Complications: Depending on size and location, symptoms can include ulceration (especially in RICH), pain, bleeding, or functional impairment if the lesion is near an eye, airway, or joint. Large NICH lesions can rarely lead to high-output cardiac failure due to significant blood shunting.

Treatment Strategies for Congenital Hemangioma

The approach to congenital hemangioma treatment is highly individualized, depending on the specific type of hemangioma, its size, location, and any associated complications. Given their distinct natural histories, management strategies differ significantly between RICH and NICH.

Type of Hemangioma	Primary Treatment Strategies
Rapidly Involuting Congenital Hemangioma (RICH)	Observation: Often the primary strategy due to spontaneous involution. Regular follow-up monitors the involution process and addresses potential complications. Symptomatic Management: For ulcerated lesions, wound care, pain management, and topical antibiotics may be necessary to prevent infection. Surgical Excision: If the lesion leaves significant residual skin laxity, scarring, or disfigurement after involution, surgical removal may be considered for cosmetic or functional improvement once involution is complete.
Non-Involuting Congenital Hemangioma (NICH)	Surgical Excision: As NICH lesions do not involute, complete surgical removal is often the definitive treatment, especially for smaller, well-localized lesions. This is typically performed when the child is older. Embolization: For larger or more complex NICH lesions, particularly those with significant blood flow, embolization (blocking blood vessels) may be used to reduce the size of the lesion or decrease blood loss during subsequent surgical removal. Laser Therapy: Pulsed dye laser may be used for superficial components or residual telangiectasias, but is generally not effective for the bulk of the lesion.
Partially Involuting Congenital Hemangioma (PICH)	Management often combines elements from both RICH and NICH strategies. This includes observation for the involuting component, followed by potential surgical removal of the persistent residual lesion.

Families should consult with a multidisciplinary team, including specialists like dermatologists, plastic surgeons, and interventional radiologists, to determine the most appropriate and tailored treatment plan.