Which Hemangiomas to Treat—and How?

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Abstract
THE MANAGEMENT of hemangiomas has been a subject of intense controversy for many decades. Once the involuting nature of these benign tumors was recognized, the obvious question became, "Why would you want to treat something which will go away on its own?"1 The answer is that, despite the benign and trivial nature of most hemangiomas, a significant minority cause functional compromise or permanent disfigurement. To complicate matters further, hemangiomas are remarkably heterogeneous in terms of size, location, and rates of growth and involution.2 They are also notoriously unpredictable early in infancy: some barely grow, while others blossom forth into huge tumors. These clinical realities make decisions regarding treatment difficult, even for the most experienced of clinicians.3 Evaluating infants with hemangiomas requires that we remember one of the most basic principles of medical decision making: "First, do no harm." It is likely that the strongly anti-interventionist bias taught by many of