In this Section

Center for Hemangiomas and Vascular Birthmarks

About Hemangiomas and Vascular Birthmarks

Vascular birthmarks are clusters of veins, arteries, or lymph channels that are found within or under the skin. They range from flat, faintly red skin lesions to bulky deep lesions that can become large enough to interfere with vision, breathing, or swallowing. Vascular birthmarks occur in about 400,000 babies each year and are generally classified as either hemangiomas or vascular malformations.

Hemangiomas, sometimes called "strawberry birthmarks," are often not visible at birth, but become visible on the skin within days or weeks of delivery.  They usually start as flat, discolored areas that may be mistaken for bruises or rashes, but grow rapidly during the first 4 - 5 months of life.  During this time, some hemangiomas may become bulky, causing significant changes in a child's appearance or function.  Others may cause painful skin ulcers or bleeding.  Growth can continue up to about 12 months of age. 

Hemangiomas begin to shrink (involute) sometime around age 1.  Some shrink rapidly leaving skin changes that are barely noticeable. Others, even with years of involution, still leave behind considerable deformities that require surgical correction.  Early evaluation of hemangiomas allows us to identify and treat those most likely to cause functional or cosmetic issues, often preventing problems before they occur.

Vascular malformations, unlike hemangiomas, are usually present at birth.  They do not undergo a period of rapid growth, but grow slowly as the child ages. They also do not shrink, and therefore often require treatment.

There are several different types of vascular malformations:

  • Venous malformations are usually deep blue or purple and collapse with pressure
  • Lymphatic malformations cause a faint blue skin discoloration or blisters and are rubbery to touch
  • Venular or capillary malformations (port wine stains) cause light to pink to dark red discoloration of the skin and may be associated with neurologic or bony abnormalities
  • Arteriovenous malformations are complex masses of arteries and veins associated with rapid blood flow and a high risk of recurrence

Treatment Options

By using the latest advances in medical, laser and surgical therapies, the physicians of the Hemangiomas and Vascular Birthmarks Program ensure the best possible result without risking or damaging healthy skin or structures surrounding the birthmark or lesion. Common treatments for hemangiomas include oral and intralesional medications, laser treatment, and surgical removal.  Vascular malformations are treated with some combination of laser therapy, intralesional occlusion under radiologic guidance, and surgical removal.

Team Approach Means Better Treatment

Patients treated in Hemangiomas and Vascular Birthmarks Program are evaluated by doctors from several specialties, each of whom provides a special skill or expertise in managing vascular birthmarks.  Our physicians collaborate to design a treatment plan customized for each patient. Often treatment will involve the participation of several members of the physician team.

Program Staff

The program’s staff includes the core specialties of plastic surgery, head and neck surgery, dermatology and radiology, with additional consultants in orthopedic surgery, general surgery, neurosurgery, gastroenterology, pulmonary medicine, dentistry, genetics and psychology.

Co-Directors:

David H. Darrow, MD, DDS
ENT/Head & Neck Surgery
Dr. Darrow performs laser, medical, and surgical management of hemangiomas and vascular malformations of the head and neck. He completed a fellowship in pediatric ENT at Children’s Memorial Hospital, Chicago, and training in management of vascular lesions with Dr. Milton Waner of the Vascular Birthmarks Institute of New York.

Judith V. Williams, MD
Pediatric Dermatology
Dr. Williams has completed residency training in both dermatology and pediatrics. She served a fellowship in pediatric dermatology at the Children’s Hospital of San Diego where she attended the Vascular Anomalies Clinic. She specializes in laser and medical treatment of vascular lesions of the skin.

George R. Hoerr, MD
Pediatric Plastic Surgery
Dr. Hoerr completed residencies in general and plastic surgery at EVMS and the University of California at Irvine and a fellowship in pediatric plastic surgery at USC/Children’s Hospital of Los Angeles.  He performs laser, medical, and surgical management of hemangiomas and vascular malformations.

Other specialists:

John C. Agola, MD
Interventional Radiology
Dr. Agola is a fellowship-trained interventional radiologist from New York University with expertise in injection of vascular malformations.

Travis D. Reeves, MD
Pediatric Head & Neck Surgery
Dr. Reeves has a special interest in vascular lesions requiring extensive soft tissue dissection, particularly around the facial nerve. He completed a fellowship training in pediatric otolaryngology at the Children's Hospitals and Clinics of Minnesota. 

Daniel W. Karakla, MD, FACS
Head & Neck Surgery
Dr. Karakla is highly skilled in surgery of complex vascular lesions involving the head and neck. He completed his fellowship training in head and neck oncologic surgery at Methodist Hospital of Indiana.

Eric J. Dobratz, MD
Plastic Surgery of the Face, Head, & Neck
Dr. Dobratz trained in Head and Neck Surgery at the University of Virginia and served a fellowship in plastic surgery of the head and neck at the University of Minnesota.  He has a special interest in nasal tip and other facial hemangiomas.

Frazier W. Frantz, MD
Pediatric Surgery
Dr. Frantz is a graduate of the surgery program at the Medical College of Virginia and completed a fellowship in pediatric surgery at Cincinnati Children's Hospital.  He has an interest in vascular lesions involving the trunk, extremities, and internal organs.

Appointments

We evaluate and treat children and adults with vascular birthmarks or hemangiomas of any kind in any location.  
To schedule an appointment, call the Vascular Anomalies Clinic Coordinator at 757.668.7793

Locations

Children's Hospital of The King's Daughters in Norfolk:
The second and third Friday mornings of each month in the ENT Clinic on the second floor, CHKD, 601 Children’s Lane, Norfolk, VA 23507

Children's Hospital of The King's Daughters Health and Surgery Center at Oyster Point:
The first Tuesday afternoon of each month on the second floor, 11783 Rock Landing Drive,
Newport News, VA 23606

About Hemangiomas and Vascular Birthmarks

Vascular birthmarks are the most common benign tumors of infancy, affecting approximately 400,000 babies each year. These are benign growths that range in appearance from flat, faintly red skin lesions to bulky deep lesions that can become large enough to interfere with vision, breathing, and swallowing.

Vascular birthmarks are generally classified as either hemangiomas or vascular malformations. Hemangiomas are not usually visible at birth, but are recognized within days or weeks of delivery. They often appear in the head and neck area, but may occur anywhere on the skin or even internally. Hemangiomas initially appear as a flat, discolored area that may be mistaken for a bruise or rash. They usually undergo two periods of rapid growth, the first at 2 to 8 weeks of age and the second between 4 and 6 months of age.

Hemangiomas, begin to regress, or involute, shortly after the first year of life. Some hemangiomas inviolate rapidly and leave behind skin changes that are barely noticeable. Others may take years to regress completely and still leave behind considerable deformities that require surgical correction. The Center's physicians use the latest advances in medical, laser, and surgical therapies to customize a treatment plan for each child.

Vascular malformations, unlike hemangiomas, are usually present at birth and do not undergo a rapid growth phase. They do not involute, and will typically grow with the patient, often requiring surgical excision.

Several different types of vascular malformations are recognized:

Venous malformations - usually deep blue or purple in color; will increase in size if affected area is held in dependent position or tourniquet applied

Lymphatic malformations (also known as lymphangiomas, or cystic hygromas) - no skin discoloration; rubbery to touch

Venular malformations (also known as port wine stains) - cause discoloration of skin from. light pink to dark red, with cobblestoning in severe cases. May be associated with neurologic or bony abnormalities. Arteriovenous malformations - variable in color; complex mass of arteries and veins associated with high blood flow; pulse may be heard through lesion.

The Center's physicians simplify the surgical excision of vascular malformations through the use of sclerosis and embolization, injection techniques performed under radiologic guidance to reduce flow through the mass. Specialists in plastic and head and neck surgery often team up to complete the removal of these difficult lesions.


Center for Hemangiomas and Vascular Birthmarks

The Center is the first interdisciplinary program in the Mid-Atlantic region for treatment of hemangiomas and vascular birthmarks in children and adults. Its staff comprises five core specialists in plastic surgery, head and neck surgery, dermatology, and radiology and additional consultants in orthopedic surgery, general surgery, neurosurgery, gastroenterology, pulmonary medicine, dentistry, genetics, and psychology.

It has been estimated that up to 60 percent of vascular birthmarks are misdiagnosed, and many are therefore treated inadequately or inappropriately. The multidisciplinary approach to these complex disorders combines several expert opinions into a comprehensive treatment plan that may involve one or more of the Center's specialists and regular follow-up with the entire staff. The Center's physicians offer the latest advances in diagnostic, medical, laser, and surgical technology including:

  • Magnetic resonance imaging (MRI), including non-invasive angiography and venography
  • Angiography and embolization
  • Local and systemic steroid therapy
  • Interferon therapy
  • Surface and intralesional laser therapy, using pulsed dye, KIT, Nd:YAG, and carbon dioxide lasers
  • Picibinal (OK-432) sclerotherapy
  • Multidisciplinary surgical resection