Dr. Jim Treat discusses essential highlights from his lecture Navigating Pediatric Vascular Anomalies: Diagnosis & Treatment Insights at the 2nd Annual Elevate-Derm Alliance Summer Conference in Park City, Utah, at the Grand Hyatt Deer Valley.

In this video

Dr. Treat frames the time course of an infantile hemangioma as the single most important thing to understand, because "it makes a lot of your decisions for you." Lesions on top of the skin blossom in the first few days, while deeper ones can take weeks to months. The most rapid growth actually happens between five and seven weeks — often before the child is even seen — which is why parents who report the lesion "doubling in size" are usually right. Growth typically stops around six months and regression begins around a year, though bigger hemangiomas break these rules. A lesion that is fully formed at birth, he cautions, is not a hemangioma and warrants a different diagnosis so something more dangerous isn't missed.

He also flags location as key: anything interfering with a function — seeing, smelling, eating, peeing, pooping — is a priority, as are cosmetically sensitive sites like the central cheek, forehead, nasal tip, lip, hands, and feet. Dr. Treat then highlights what he calls the most important entity providers don't know about: CM-AVM syndrome. Multiple small, thumbprint-like red oval patches — easy to pass over — especially with a family history of AVMs, can be a marker of AVMs in the brain or spine. As he puts it, dermatology providers are "the only ones who are going to see it," and these children should get genetic testing (RASA1 or EPHB4) and screening.

  • Know the hemangioma time course cold: most rapid growth is at 5–7 weeks, growth usually stops around 6 months, and regression starts around a year — with plenty of exceptions for larger lesions.
  • A vascular lesion that is fully formed at birth is not a hemangioma; make a different diagnosis and rule out something more dangerous.
  • Treat based on function and cosmetics — hemangiomas near the eyes, nose, lips, or on hands and feet matter more than one on the side of the belly.
  • Multiple small thumbprint-like red oval patches, especially with a family history of AVMs, may signal CM-AVM syndrome and underlying brain or spine AVMs.
  • Suspected CM-AVM patients (RASA1 or EPHB4 mutation) should get genetic testing and screening — dermatology may be the only specialty that catches the subtle skin findings.