Hemangioma is the most common benign vascular tumor of infancy with a 10-12% incidence at 1 year of age. It usually appears a few weeks after birth, grows very rapidly until 10-12 months of age (proliferative) and spontaneously involutes within 5-10 years.
Figure 1: Natural evolution of hemangioma
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| Age 3 month; proliferating hemangioma on the right cheek | Age 5 years; note the nice involution of this hemangioma |
(Copyright © 1999 L.M. Boon) Therefore, most hemangiomas do not need any treatment but a rigourous clinical follow-up. However, during the proliferative phase, hemangioma can cause deformation or ulceration, bleeding or even obstruction of vital organs. Pharmacologic therapies (local/systemic corticosteroid or interferon a-2a) will be the treatment of choice of proliferating hemangiomas.
Figure 2: Successful treatment with systemic corticosteroid  |  |
| 3-month-old girl with proliferating hemangioma on the upper eyelid causing amblyopia. | Result after 5,5 months of systemic corticotherapy; note the nice involution of the hemangioma at 2 years of age. |
Surgical resection is also sometimes mandatory .
Figure 3: Surgical resection of involuted hemangioma  |  |
| One-year-old girl with proliferated hemangioma. | Two years after surgical resection performed at age 3 years. |
(Copyright © 1999 L.M. Boon) Kaposiform hemangioendothelioma is another rare but life-threatening vascular tumor that can be seen in children. This vascular tumor has the particularity to trap platelets so that the child is left with a very low platelet count (less than 40 000/ mm3). Treatment is very difficult. Several drugs have been used with various success rate (corticosteroid, interferon a-2a, chemotherapy), as well as radiotherapy in some instances.
Figure 4  |
| 6-month-old boy with hemangioendothelioma complicated with Kasabach-Merritt phenomenon (platelets count: 8000/mm3). |
(Copyright © 1999 L.M. Boon)