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Infantile hemangiomas: Epidemiology, pathogenesis, clinical features, and complications

Denise W Metry, MD
Section Editor
Moise L Levy, MD
Deputy Editor
Rosamaria Corona, MD, DSc


Vascular lesions of infants and children are classified into two major types: tumors and vascular malformations [1]. Infantile hemangiomas are the most common vascular tumors. Other examples of vascular tumors include pyogenic granuloma, kaposiform hemangioendothelioma, and tufted angioma. So-called rapidly involuting (RICH) and non-involuting (NICH) "congenital" hemangiomas appear histopathologically to be hybrids showing features of both vascular tumor and malformation. Because cases of RICH evolving into NICH have been reported, it has been suggested that these two entities lie within the same spectrum [2,3].

Infantile hemangiomas are characterized by a growth phase and an involution phase. In contrast, vascular malformations, which are structural anomalies derived from capillaries, arteries, veins, lymphatics, or a combination thereof, grow in proportion to the child but generally do not regress. Vascular malformations are discussed separately. (See "Vascular lesions in the newborn".)

Despite their benign and self-limited nature, some hemangiomas can cause complications such as ulceration and permanent disfigurement. In addition, some may compromise vital organ function or herald underlying developmental anomalies of the spine, central nervous system, circulatory system, and/or eyes. Hemangiomas in the liver, brain, or gastrointestinal tract may rarely cause life-threatening complications. Large size, facial location, and/or segmental morphology are the most common predictors of poor short-term outcomes as measured by complication and treatment rates [4]. (See 'Segmental lesions' below.)

An overview of the epidemiology, pathogenesis, clinical features, and complications of infantile hemangiomas will be presented here. The evaluation and management are discussed separately. (See "Evaluation and diagnosis of infantile hemangiomas" and "Management of infantile hemangiomas".)


Hemangiomas are the most common tumors of infancy. The true incidence of infantile hemangiomas is unknown [5]. Although they are classically said to occur in up to 10 percent of Caucasian infants [6,7], 4 to 5 percent is probably a better estimate [5,8]. Infantile hemangiomas are generally noticed within the first few days to months of life [9,10]. Although most hemangiomas occur sporadically, familial transmission in an autosomal dominant fashion has been reported [11].


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