Hemangioma: types, diagnosis, and treatment | Omicron Clinic<\/title>\n<meta name=\"description\" content=\"A hemangioma is a benign tumor of the blood or lymph vessels. Cherry angioma, hemangioma, port-wine stain, spider angioma, laser, and treatment in Quebec.\">\n<meta name=\"keywords\" content=\"angiome traitement, angiome rubis, h\u00e9mangiome nourrisson, angiome plan, angiome araign\u00e9e, angiome stellaire, angiome laser, angiome cutan\u00e9, angiome Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap*{font-family:'Poppins',sans-serif;box-sizing:border-box}\n.co-wrap{max-width:1100px;margin:0 auto;padding:30px 0 60px}\n.co-label{font-family:'Cinzel',serif;font-size:14px;font-weight:bold;letter-spacing:1px;text-transform:uppercase;color:#4D6577;margin-bottom:14px;display:block}\n.co-wrap h1{font-size:32px;font-weight:500;color:#323C52;margin:0 0 22px;line-height:1.2}\n.co-intro{font-size:16px;line-height:1.75;color:#4D6577;margin-bottom:36px;padding-bottom:32px;border-bottom:1px solid rgba(77,101,119,.2)}\n.co-wrap h2{font-size:20px;font-weight:600;color:#323C52;margin:32px 0 12px}\n.co-wrap p{font-size:15px;color:#4D6577;line-height:1.7;margin-bottom:14px}\n.co-list{list-style:none;padding:0;margin:12px 0 24px}\n.co-list li{font-size:15px;color:#4D6577;padding:10px 14px 10px 38px;margin-bottom:8px;border-radius:6px;position:relative;background:rgba(77,101,119,.06);border-left:3px solid #4D6577}\n.co-list li::before{content:\"\u2713\";position:absolute;left:12px;font-weight:700;color:#4D6577}\n.co-table{width:100%;border-collapse:collapse;margin:14px 0 22px;font-size:14px;border-radius:8px;overflow:hidden;table-layout:fixed}\n.co-table thead tr{background:#323C52;color:#fff}\n.co-table thead th{padding:11px 16px;text-align:left;font-weight:600;font-size:13px}\n.co-table tbody tr:nth-child(even){background:rgba(77,101,119,.06)}\n.co-table tbody tr:nth-child(odd){background:#fff}\n.co-table td{padding:10px 16px;color:#4D6577;border-bottom:1px solid rgba(77,101,119,.12);font-size:14px;vertical-align:top}\n.co-table td:first-child{font-weight:600;color:#323C52}\n.co-infobox{display:flex;gap:12px;background:rgba(77,101,119,.06);border-radius:8px;border-left:4px solid #4D6577;padding:14px 18px;margin:18px 0 28px;font-size:14px;color:#4D6577;line-height:1.65}\n.co-infobox .ico{font-size:18px;flex-shrink:0}\n.co-urgence{background:#fff8f8;border-left:5px solid #c0392b;border-radius:6px;padding:20px 26px;margin:24px 0 32px}\n.co-urgence .co-urgence-titre{font-size:13px;font-weight:700;color:#c0392b;letter-spacing:1.5px;text-transform:uppercase;margin-bottom:10px}\n.co-urgence p{color:#5a2020;font-size:14px;margin:0 0 10px;line-height:1.7}\n.co-urgence p:last-child{margin-bottom:0}\n.co-disclaimer{font-size:13px;color:#8a9aaa;font-style:italic;border-top:1px solid rgba(77,101,119,.15);padding-top:24px;margin-top:40px;line-height:1.6}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Dermatology & Vascular Surgery & Pediatrics & Family Medicine<\/span>\n <h1>Angioma<\/h1>\n\n <div class=\"co-intro\">\n The term \u00abangioma\u00bb refers to a heterogeneous group of benign tumors or malformations of the blood and lymphatic vessels. The modern classification, proposed by ISSVA (International Society for the Study of Vascular Anomalies) in 1996 and revised in 2018, basically distinguishes two main categories: vascular tumors (with active cell proliferation - infantile hemangiomas, congenital hemangiomas, tufted angiomas, hemangioendotheliomas) and vascular malformations (static structural anomalies without cell proliferation - capillary, venous, arteriovenous, lymphatic or mixed malformations). This distinction is clinically essential, as it determines prognosis and therapeutic strategy: infantile hemangiomas have an active growth phase followed by spontaneous involution, whereas vascular malformations persist and evolve with the patient. In everyday family practice, the most frequently encountered lesions are ruby angioma (senile hemangioma - a small, bright red lesion, benign and extremely common in adults over the age of 30), spider or stellate angioma (associated with cirrhosis or pregnancy), infantile hemangioma (most common vascular tumor in children - 4 to 10 % of infants) and plano angioma (capillary malformation - congenital wine stain). Treatment varies considerably according to type: from simple monitoring (asymptomatic ruby angioma), to oral propranolol (complicated infantile hemangioma), to pulsed dye laser (PDL) or Nd:YAG laser (plano angioma, symptomatic ruby angioma), to surgery or embolization for extensive or dangerous forms.\n <\/div>\n\n <h2>Classification, types, and pathophysiology<\/h2>\n <ul class=\"co-list\">\n <li><strong>Classification ISSVA 2018 and Pathophysiology of Vascular Anomalies<\/strong> international reference classification (ISSVA 2018 - update of Mulliken and Glowacki 1982 classification): category 1 - vascular tumors (active endothelial cell proliferation): infantile hemangioma (IH): most frequent vascular tumor of childhood + growth phase + involution phase \u2192 GLUT-1 positive (specific immunohistochemical marker - North 2000 - Microcirculation) + Rapidly Involuting Congenital Hemangioma (RICH): present at birth + involution in 12-14 months + GLUT-1 negative + Non-Involuting Congenital Hemangioma (NICH): persists throughout life + GLUT-1 negative + Partially Involuting Congenital Hemangioma (PICH) + Tufted Angioma + Kapositic Hemangioendothelioma (KHE) : rare + associated with Kasabach-Merritt phenomenon (thrombocytopenia + DIC + microangiopathic hemolytic anemia \u2192 significant mortality) \u2192 treatment with vincristine + sirolimus \u2192 category 2 - vascular malformations (structural anomalies - no active proliferation): capillary malformations (CM): plane angioma (port-wine stain - nevus flammeus) + telangiectasias + spider angioma + arteriovenous malformations (AVM): abnormal connection between arteries and veins without intermediate capillary bed \u2192 high-velocity flow \u2192 progressive \u2192 expansion under the effect of hormones + trauma + pregnancy + venous malformations (MV): slow flow \u2192 local thrombosis + pain + thrombophlebitis + lymphatic malformations (ML): former \u00ablymphangioma\u00bb \u2192 lymphatic cyst + neonatal hygroma colli \u2192 mixed malformations (capillaro-venous + capillaro-lymphatic + etc.).); pathophysiology according to type: infantile hemangiomas: cellular origin controversial - placental hypothesis dominant : Barn\u00e9s 2005 - Placenta: placental endothelial stem cells (GLUT-1+) \u2192 migration in utero \u2192 VEGF-dependent proliferation (vascular endothelial growth factor) in the first months of life \u2192 VEGF + IGF-2 + bFGF \u2192 proliferation \u2192 then apoptosis-mediated involution + increased TGF-\u03b2 + reduced VEGF + HI risk factors: prematurity (75 years \u2192 genetic factors + sun exposure + immunosuppression + pregnancy + spider angioma (angiome stellaire - spider angioma - spider nevus): dilated central arteriole + radiating capillaries \u2192 reddens at central pressure + whitens \u2192 origin: hyperoestrogenism (pregnancy + estroprogestogenic contraceptives + hepatic cirrhosis) + spider angioma \u2192 clinical sign of advanced chronic liver disease + Foutch 1988 - American Journal of Gastroenterology: >5 spider angiomas \u2192 significant association with cirrhosis and portal hypertension<\/li>\n <li><strong>Clinical Presentation of the Main Types of Angiomas:<\/strong> infantile hemangioma (IH) - vascular tumor of infants: epidemiology: 4-10 % of Caucasian infants + premature infants up to 30 % + F\/H = 3:1 \u2192 localizations: head and neck (60 %) + trunk (25 %) + limbs (15 %) + superficial forms (formerly \u00abstrawberries\u00bb): bright red + relief + well delimited + deep forms (formerly \u00abcavernous hemangioma\u00bb): subcutaneous bluish nodule + mixed forms \u2192 natural evolution in 3 phases: proliferation: birth to 6-9 months \u2192 rapid growth + plateau: 9-12 months \u2192 involution: 1-7 years \u2192 complete involution in 50 % of cases at 5 years + 70 % at 7 years + residual sequelae in 20-40 % of cases (fibrosis + telangiectasias + flaccid skin - especially if HI \u22652 cm) \u2192 Leaute-Labreze 2008 - NEJM : discovery of the effect of propranolol (non-selective beta-blocker) in the treatment of complicated HI \u2192 therapeutic revolution \u2192 complicated HI requiring active treatment (15-20 % of HI): periorbital location (risk of amblyopia) + nasal location (Cyrano - risk of permanent distortion) + labial location (risk of scarring + functional discomfort) + ulcerated HI (pain + superinfection) + extensive facial segmental HI (risk of PHACE syndrome : Posterior fossa anomalies + Facial hemangiomas + Arterial + Cardiovascular anomalies + Eye + Sternal\/Endocrine anomalies) + Subglottic HI (stridor + respiratory distress) + Multiple hepatic HI (hypothyroidism + shunt heart failure) + HI >5 cm (risk of LUMBAR or PELVIS syndrome - spinal dysraphism + anal imperforation + genitourinary anomalies) ; angioma planus (capillary malformation - port-wine stain) : present from birth + pink to dark red macule + often unilateral + geographic contours + frequent facial localization (V1\/V2 territory of trigeminal) \u2192 darkens + thickens with age + may develop nodules + complications: glaucoma (if V1 + periorbital) + Sturge-Weber syndrome (4 % of V1 facial plane angiomas) \u2192 cerebral MRI + fundus recommended if plane angioma in ophthalmic territory + Klippel-Trenaunay: lower limb plane angioma + varicose veins + limb hypertrophy \u2192 clinical diagnosis; ruby angioma (senile hemangioma \/ cherry angioma): bright red to purple papule or macule + 1-5 mm + smooth surface + well delimited + whitens on incomplete vitropression (vascular flow) + preferential location: trunk + arms + shoulders + increases in number with age + benign + no malignant degeneration + clinical diagnosis (dermoscopy: homogeneous red lacunae separated by whitish septa - \u00abred globules\u00bb in dermoscopy) \u2192 treatment if cosmetic discomfort or post-traumatic bleeding; spider angioma (spider nevus): red punctiform central arteriole + 0.5-1 cm radiating capillaries + clears on central compression + localizations: face + d\u00e9collet\u00e9 + upper limbs + children: physiological in small numbers + adults: >5 spider angiomas \u2192 liver check-up + pregnancy: physiological (hyperoestrogenism) \u2192 post-partum regression; essential telangiectasias: permanent dilatations of small superficial vessels (capillaries + venules) + face (couperose) + legs (reticular veins + telangiectasias) + Rendu-Osler-Weber (hereditary hemorrhagic telangiectasia - HHT) : ENG (endoglin) or ACVRL1 (ALK1) mutation + autosomal dominant \u2192 mucosal + digestive telangiectasias + recurrent epistaxis + pulmonary + hepatic + cerebral AVMs \u2192 to be evoked if epistaxis + unexplained hemoptysis + iron-deficiency anemia without obvious cause \u2192 family genetic screening<\/li>\n <\/ul>\n\n <h2>Diagnosis, treatment and follow-up<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:200px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Type \/ intervention<\/th><th>Diagnostic and therapeutic modalities<\/th><th>Evidence and recommendations<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Infantile hemangioma (IH) \u2014 diagnosis and treatment<br><small style=\"font-weight:400;color:#7a8fa0;\">GLUT-1 \u2014 propranolol \u2014 timolol \u2014 corticosteroids \u2014 laser \u2014 PHACE \u2014 Ulcerated Hemangioma \u2014 pediatric follow-up<\/small><\/td>\n <td>Diagnosis of HI: clinical in the vast majority of cases + no biopsy necessary if typical presentation \u2192 ultrasound-Doppler (high flow - intra-lesional arterial flow) if doubt \u2192 MRI if deep HI + undetermined subcutaneous localization + suspicion of PHACE syndrome + extensive segmental HI \u2192 GLUT-1 immunohistochemistry if biopsy performed \u2192 GLUT-1 positive = HI (excellent sensitivity and specificity - North 2000 - Microcirculation) \u2192 to be distinguished from: congenital hemangioma (RICH\/NICH - GLUT-1 negative) + venous malformation + tufted angioma + kaposiform hemangioendothelioma \u2192 systemic workup if multiple hepatic HI (>5 skin lesions \u2192 hepatic HI screening by ultrasound) \u2192 TSH dosage (hypothyroidism by overexpression of iodothyronine deiodinase type 3 by HI cells) \u2192 risk of profound hypothyroidism + neurodevelopmental delay ; oral propranolol - reference treatment for complicated ICH (since Leaute-Labreze 2008 - NEJM): mechanism: vasoconstriction + reduction in VEGF and bFGF expression + promotion of apoptosis of HI endothelial cells \u2192 Leaute-Labreze 2015 - NEJM (PRIDE trial): international multicenter RCT n=456 infants \u2192 propranolol 3 mg\/kg\/d \u00d7 6 months vs placebo \u2192 success at 24 weeks: 60 % vs 4 % \u2192 worldwide standard of care \u2192 initiation scheme: in hospital or specialized consultation \u2192 ECG + blood glucose before initiation + cardiac workup if pathology suspected + contraindications: PHACE with severe arterial abnormalities (risk of stroke due to vasoconstriction) + asthma + AV block + bradycardia + neonatal hypoglycemia \u2192 dose: 1 mg\/kg\/d \u00d7 1 week \u2192 2 mg\/kg\/d \u00d7 1 week \u2192 3 mg\/kg\/d (maximum dose) \u2192 monitoring: HR + BP + blood glucose when dose is increased \u2192 duration: 6 months (generally until age 12-15 months) \u2192 adverse effects: hypoglycemia (take with meals - fasting to be avoided) + bradycardia + bronchospasm + sleep disorders \u2192 recurrence on discontinuation: 10-25 % \u2192 resumption of propranolol \u2192 timolol gel 0.5 % ophthalmic topical use: alternative to oral propranolol for localized superficial IH + superficial periorbital IH \u2192 P\u00fcttgen 2016 - JAMA Dermatology: timolol gel 0.5 % \u00d7 2\/d \u2192 partial to complete response in 60-70 % of superficial thin IH \u2192 low but not zero systemic absorption \u2192 systemic corticoids (prednisone 2-3 mg\/kg\/d): 2nd-line option if propranolol contraindicated or in combination \u2192 recognized efficacy but adverse effects (hypertension + Cushing's + growth retardation) \u2192 pulsed dye laser (PDL 585\/595 nm): treatment of residual post-involution sequelae + telangiectasias + very thin superficial HI in involution phase \u2192 not very effective on thick HI in growth phase \u2192 ulcerated HI: local care (oily dressings + vaseline + oily tulle) + oral propranolol (accelerates healing of ulceration) + topical antibiotic therapy if superinfection (fusidic acid) + analgesia (paracetamol + oral sucrose in infants) + PDL laser if persistent<\/td>\n <td>Key data on propranolol in IH: Leaute-Labreze 2008 - NEJM: initial case report \u2192 propranolol 2 mg\/kg\/d \u2192 rapid, dramatic regression of IH \u2192 chance discovery \u2192 therapeutic revolution \u2192 Leaute-Labreze 2015 - NEJM (PRIDE trial): RCT n=456 \u2192 propranolol 3 mg\/kg\/d \u00d7 6 months \u2192 success rate 60 % vs 4 % placebo \u2192 p<0.001 \u2192 worldwide standard of care \u2192 Drolet 2013 - Pediatrics: multicenter cohort \u2192 propranolol \u2192 response from the first weeks \u2192 plateau at 6 months + Solman 2018 - British Journal of Dermatology: meta-analysis \u2192 oral propranolol superior to topical timolol + oral corticosteroids for complicated IH \u2192 consensus indication: localized periorbital + nasal + labial + subglottic + ulcerated + PHACE IH without vascular contraindication; position of Hypertension Canada and pediatric societies: CPS (Canadian Pediatric Society) 2023: propranolol = 1st-line treatment of complicated IH \u2192 initiation by physician specialized in pediatric dermatology or pediatric surgery \u2192 close follow-up for first few weeks + Hoeger 2015 - Journal of the American Academy of Dermatology: algorithm for management of IH \u2192 indications for treatment + contraindications for propranolol + specialized referral criteria<\/td>\n <\/tr>\n <tr>\n <td>Angioma plan \u2014 laser treatment and follow-up<br><small style=\"font-weight:400;color:#7a8fa0;\">PDL \u2014 Nd:YAG \u2014 laser 532 nm \u2014 Sturge-Weber \u2014 glaucoma \u2014 results \u2014 recurrence \u2014 number of sessions<\/small><\/td>\n <td>Planar angioma treatment with vascular laser: reference laser: pulsed dye laser (PDL - Pulsed Dye Laser) 585\/595 nm: principle of selective photolysis (Anderson and Parrish 1983 - Science): the laser is selectively absorbed by oxyhemoglobin (absorption peak at 577-585 nm) \u2192 coagulation of dilated vessels in the dermis \u2192 epidermal sparing \u2192 parameters: wavelength 585 or 595 nm + pulse duration 0.45-40 ms + energy density (fluence) 6-12 J\/cm\u00b2 + spot 5-10 mm \u2192 results: partial to complete whitening in 60-80 % of cases + Renfro 1993 - Journal of the American Academy of Dermatology: PDL \u2192 complete response 15 % + partial response (>50 % improvement) 60 % \u2192 variable results depending on location (central face best response) + thickness (thick angioma \u2192 less good response) + color (pinkish \u2192 better response than dark red or violet) + age (early treatment in infants \u2192 best results - Enjolras 1990 - Pediatrics) \u2192 number of sessions: 5-20 sessions or more depending on response \u2192 spacing: 6-8 weeks \u2192 insufficient results from PDL alone if: very thick angioma (nodules) + dark violet angioma + resistant angioma \u2192 alternatives and complements to PDL: Nd:YAG 1064 nm laser: deeper penetration \u2192 treatment of thick angiomas + resistant to PDL + PDL + Nd:YAG combination: better response for resistant angiomas + KTP (potassium-titanyl-phosphate) 532 nm laser: effective on telangiectasias and small flat angiomas + IPL (Intense Pulsed Light): intense pulsed light - less effective than PDL for flat angiomas, but useful for diffuse rosacea + Nd:YAG 1064 nm long pulse: treatment of choice for venous malformations + deep angiomas; eye protection mandatory (leaded glasses or eye cones) if periorbital treatment + local or general anesthesia in infants and children; post-laser care: ecchymoses (purpura) for 10-14 days (unavoidable with PDL - photolysis of intravascular red blood cells) + erythema + edema \u2192 local care: vaseline + avoid the sun 4-6 weeks + SPF 50+ sunscreen \u2192 post-inflammatory hyperpigmentation (dark skin - Fitzpatrick IV-VI): increased risk \u2192 test on a small area \u2192 recurrence after treatment: frequent (neoformed vessels) \u2192 maintenance sessions \u2192 long-term results: whitening maintained in 50-70 % of cases at 5 years if early and complete treatment; Sturge-Weber syndrome - multidisciplinary management: systematic screening: planar angioma in ophthalmic territory (V1) \u2192 cerebral MRI with gadolinium (leptomeningeal angioma) + fundus + intraocular pressure (glaucoma) + EEG + neuropsychological assessment \u2192 Comi 2011 - Neurology: MRI + planar angioma V1 \u2192 leptomeningeal angioma in 8-26 % of cases depending on laterality \u2192 treatment: aspirin 3-5 mg\/kg\/d (prophylaxis of ischemic strokes related to stasis in leptomeningeal angioma) + antiepileptics (comitiality) + glaucoma: topical beta-blockers + trabeculectomy if refractory + early PDL laser (as early as the first months) for planar angioma \u2192 better results than offline<\/td>\n <td>Selective photolysis - physical foundations of laser processing : Anderson and Parrish 1983 - Science: theory of selective photolysis \u2192 wavelength selectively absorbed by chromophoric target (oxyhemoglobin) \u2192 pulse duration less than thermal relaxation time of target vessel \u2192 sparing of adjacent tissue \u2192 physical basis of all vascular lasers \u2192 Tan 1992 - Archives of Dermatology: PDL optimized for pediatric planar angiomas \u2192 best results if initiated early (before 1 year) + Renfro 1993 - JAAD: PDL results in planar angiomas \u2192 complete whitening 15 % + partial 60 % over 8-10 sessions \u2192 localization + depth-dependent efficacy + Nguyen 2012 - Lasers in Surgery and Medicine: PDL vs Nd:YAG in resistant planar angiomas \u2192 superior combination + Rohrer 2010 - Dermatologic Surgery: IPL vs PDL \u2192 superior PDL for planar angiomas; treatment of glaucoma associated with Sturge-Weber syndrome: Sujansky 1993 - American Journal of Medical Genetics: prevalence of glaucoma in SWS: 30-70 % \u2192 congenital or juvenile glaucoma + medical treatment (beta-blockers + carbonic anhydrase inhibitors) then surgical if refractory + Comi 2011 - Neurology: early MRI recommended in any child with V1 planar angioma \u2192 presence of leptomeningeal angioma \u2192 predictive factor for neurological severity + aspirin + early neurological management<\/td>\n <\/tr>\n <tr>\n <td>Cherry angiomas and spider angiomas \u2014 treatment and clinical significance<br><small style=\"font-weight:400;color:#7a8fa0;\">Laser \u2014 electrocoagulation \u2014 cryotherapy \u2014 liver function test \u2014 pregnancy \u2014 couperose \u2014 IPL<\/small><\/td>\n <td>Ruby angioma - management: therapeutic abstention justified if asymptomatic (benign lesion + no malignant potential) \u2192 indications for treatment: aesthetic discomfort + repeated bleeding (rubbing or shaving trauma) + troublesome localization (finger + face); treatment options: pulsed dye laser (PDL 595 nm): 1st intention if lesion <3 mm \u2192 one to two sessions \u2192 KTP 532 nm laser: very effective for flat + small lesions \u2192 Nd:YAG 1064 nm long pulse laser: for larger or deep ruby angiomas + electrocoagulation (monopolar electrosurgery): classic in-office treatment \u2192 fine needle + high-frequency current \u2192 coagulation of the central arteriole \u2192 high efficacy on small lesions \u2192 risk of scarring if too intense \u2192 advantage: accessible + inexpensive + without laser equipment \u2192 liquid nitrogen cryotherapy: less effective than laser or electrocoagulation for ruby angiomas \u2192 risk of hypopigmentation on dark skin \u2192 may leave a white scar \u2192 IPL (intense pulsed light): effective for diffuse multiple ruby angiomas (trunk + shoulders) \u2192 single-session surface treatment of large areas; couperose (erythematotelangiectatic rosacea) and facial telangiectasias: IPL + PDL + KTP laser \u2192 very effective for facial telangiectasias + Nd:YAG laser for reticular leg veins (1-3 mm) + foam sclerosis (polidocanol) for varicose veins and telangiectasias of the lower limbs + fine electrocoagulation on isolated nasal telangiectasias; spider angioma - clinical significance and management: in children: often physiological + in small numbers (<5) + disappears spontaneously before puberty \u2192 no systematic workup if 5 + outside pregnancy \u2192 systematic liver workup: ASAT + ALAT + GGT + PAL + bilirubin + albumin + PT + CBC (thrombocytopenia \u2192 portal hypertension) \u2192 echo-abdominal if workup abnormal \u2192 Foutch 1988 - American Journal of Gastroenterology: >5 spider angiomas \u2192 sensitivity 75 % + specificity 84 % for cirrhosis or severe liver disease \u2192 pregnancy: physiological + regression within 3 months postpartum \u2192 estroprogestative contraceptives: partial regression on discontinuation \u2192 treatment if persistent or cosmetically bothersome: PDL or KTP laser on the central arteriole \u2192 one session often sufficient + fine electrocoagulation of the central arteriole \u2192 immediate efficacy \u2192 slight scarring possible if too intense; hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber - HHT): Cura\u00e7ao diagnostic criteria (Shovlin 2000 - American Journal of Medical Genetics): recurrent epistaxis + mucosal and cutaneous telangiectasias + visceral AVMs (pulmonary + hepatic + cerebral) + 1st-degree family history \u2192 HHT certain if 3 criteria + probable if 2 + improbable if 1 \u2192 screening for visceral AVMs: thoracic CT (pulmonary AVMs \u2192 risk of paradoxical stroke + cerebral abscess) + cardiac echo with contrast (right-left shunt) + cerebral MRI (cerebral AVMs) + hepatic angioscan (hepatic AVMs - high-flow heart failure) \u2192 HHT treatment: bevacizumab (anti-VEGF) \u2192 reduction of epistaxis (Dupuis-Girod 2012 - JAMA) + thalidomide \u2192 embolization of pulmonary AVMs + embolization or surgery of cerebral AVMs <\/td>\n <td>Data on treatment efficacy for ruby and spider angiomas: Sommer 2002 - Dermatologic Surgery: PDL vs electrocoagulation for ruby angiomas \u2192 PDL superior in terms of aesthetic results + less scarring \u2192 electrocoagulation: comparable efficacy but slightly higher scar rate \u2192 both effective in daily practice + Hedelund 2006 - Lasers in Medical Science: KTP 532 nm laser \u2192 highly effective for ruby angiomas and facial telangiectasias \u2192 excellent results in 1-2 sessions + Goldberg 2011 - Dermatologic Surgery: IPL + multiple angiomas + rosacea \u2192 improvement in 70-80 % of cases \u2192 less precise than PDL on individual lesions but useful for extensive surfaces; HHT - therapeutic data: Dupuis-Girod 2012 - JAMA: RCT bevacizumab IV in HHT + epistaxis \u2192 significant reduction in duration and frequency of epistaxis \u2192 low NNT \u2192 bevacizumab = validated option in severe HHT + Faughnan 2011 - Annals of Internal Medicine: HHT guidelines \u2192 systematic screening for pulmonary AVMs by chest CT recommended in any HHT patient from diagnosis \u2192 embolization if AVM >3 mm \u2192 reduction in paradoxical strokes and brain abscesses by 80 %<\/td>\n <\/tr>\n <tr>\n <td>Complex vascular malformations \u2014 multidisciplinary diagnosis and management<br><small style=\"font-weight:400;color:#7a8fa0;\">MAV \u2014 venous malformation \u2014 lymphatic \u2014 KHE \u2014 Kasabach-Merritt \u2014 sirolimus \u2014 embolization \u2014 surgery<\/small><\/td>\n <td>Cutaneous and subcutaneous arteriovenous malformations (AVMs): clinical presentation: warm pulsatile mass + palpable quivering + systolic murmur on auscultation + local hyperthermia + distal ischemia if vascular steal + high-flow heart failure if voluminous \u2192 evolution: progressive (worsening under hormones + trauma + pregnancy + incomplete exeresis attempt \u2192 recruitment of new vessels) \u2192 Schobinger classification (1990 - Seminars in Vascular Surgery): stage I (quiescence): pinkish + warm + symptomless AV arteriole \u2192 stage II (expansion): pulsation + tremor + varicosities \u2192 stage III (destruction): ulceration + bleeding + pain + osteolysis if bony \u2192 stage IV (decompensation): heart failure + diagnosis: MRI with gadolinium (arterial flow-void) + angioscanner \u2192 conventional angiography: gold standard before embolization \u2192 treatment: endovascular embolization (feeder arteries) + surgical excision within 24-72h post-embolization \u2192 excision alone or embolization alone \u2192 almost certain recurrence + contraindicated injection of sclerosant alone \u2192 sirolimus (mTOR inhibitor): effective in complex AVMs + Parkes-Weber syndrome \u2192 Venot 2018 - Nature: sirolimus \u2192 lesion reduction in PIK3CA-related overgrowth spectrum (PROS) \u2192 somatic PIK3CA mutations \u2192 alpelisib treatment (PI3K inhibitor) + cerebral AVMs: see neurosurgery \/ interventional neuroradiology; venous malformations (VMs): presentation: bluish mass + compressible + non-pulsatile + increases in declive position + painful on pressure \u2192 phleboliths (round calcifications) = pathognomonic + localized intravascular coagulopathy (localized DIC - fibrin + elevated D-dimers) in extensive forms \u2192 risk of VTE + diagnosis: T2 MRI (hypersignal) + echo-Doppler (low flow) + treatment: percutaneous ethanol or polidocanol sclerotherapy + intravascular 1064 nm Nd:YAG laser (EVLT - endovenous laser treatment) + surgical excision if localized + sirolimus (rapamycin) in extensive or complex forms : Hammer 2018 - Pediatric Blood and Cancer: sirolimus \u2192 reduction in coagulopathy + volume + pain in complex venous malformations; lymphatic malformations (ML): presentation: macrocystic (large logettes - former \u00abcystic lymphangioma\u00bb) + microcystic (superficial vesicles) + mixed \u2192 frequent localization: neck (neonatal hygroma colli) + axilla + mediastinum + tongue + orbit \u2192 prenatal diagnosis possible (hygroma colli \u2192 T21 + Turner to be excluded) \u2192 treatment: percutaneous sclerotherapy with OK-432 (inactivated streptococcus) or doxycycline + surgical resection + sirolimus: reduction of complex MLs (Adams 2016 - Pediatrics); kaposiform hemangioendothelioma (KHE) and Kasabach-Merritt phenomenon: KHE = childhood vascular tumor + intratumoral platelet resorption \u2192 profound thrombocytopenia + DIC + microangiopathic hemolytic anemia \u2192 mortality 10-30 % without treatment \u2192 treatment: sirolimus (rapamycin) - Kai 2014 - Pediatrics: sirolimus 0.8 mg\/m\u00b2\/d \u2192 resolution of Kasabach-Merritt phenomenon in 80-90 % of cases \u2192 current gold standard \u2192 corticosteroids + vincristine as 2nd-line treatment if sirolimus insufficient; reference center for vascular anomalies: complex forms \u2192 refer to a specialized multidisciplinary center: CHU \u2192 team: dermatologist + vascular surgeon + interventional radiologist + hematologist + neurologist depending on involvement <\/td>\n <td>Data on sirolimus in complex vascular anomalies: Venot 2018 - Nature: sirolimus + PIK3CA mutations (PROS - PIK3CA-related overgrowth spectrum) \u2192 reduction of vascular lesions + functional improvement \u2192 PIK3CA mutations found in infantile hemangiomas + planar angiomas + AVMs + CLOVES syndrome + Kai 2014 - Pediatrics: sirolimus in KHE + Kasabach-Merritt \u2192 resolution of thrombocytopenia in 80-90 % \u2192 sirolimus = standard of care in KHE \u2192 Hammer 2018 - Pediatric Blood and Cancer: sirolimus in complex venous malformations \u2192 significant reduction in coagulopathy + volume + pain \u2192 Adams 2016 - Pediatrics: sirolimus in lymphatic malformations + clinical improvement in 85 % of cases; Schobinger 1990 - Seminars in Vascular Surgery: classification of AVMs into 4 stages \u2192 guides therapeutic decisions + fundamental precautions in AVMs: never perform incomplete excision alone without prior embolization \u2192 certain aggravation + recruitment of new arterial pedicles \u2192 Rosen 2009 - Seminars in Interventional Radiology: embolization + surgery within 48h \u2192 better results than delayed surgery<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span><strong>Vascular tumor or vascular malformation: a clinically essential distinction:<\/strong> Infantile hemangiomas (vascular tumors) have a growth phase and then spontaneously involute\u2014the majority do not require treatment. Vascular malformations (port-wine stains, venous malformations, AVMs) do not involute and evolve with the patient. A facial port-wine stain in the V1 territory requires screening for Sturge-Weber syndrome. More than 5 spider angiomas in a non-pregnant adult warrant hepatic evaluation. Complicated infantile hemangiomas (periorbital, nasal, ulcerated, subglottic) should be treated rapidly with oral propranolol under specialized supervision.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations Requiring Urgent Medical Attention or Emergency Room Visit<\/div>\n <p><strong>Infant with rapidly growing peri-orbital, nasal, or labial infantile hemangioma, or with stridor<\/strong> -> Functional or life risk -> Urgent consultation with pediatric dermatology or pediatric surgery -> Immediate initiation of oral propranolol -> Subglottic location: risk of airway obstruction -> Pediatric emergency if stridor + respiratory distress.<\/p>\n <p><strong>Infant or child with large hemangioma + thrombocytopenia + DIC + hemolytic anemia (pallor + jaundice + purpura)<\/strong> \u2192 Kasabach-Merritt phenomenon on kaposiform hemangioendothelioma \u2192 pediatric hematologic emergency \u2192 hospitalization in a specialized center \u2192 sirolimus + corticosteroids + vincristine according to protocol \u2192 mortality 10\u201330 % without treatment.<\/p>\n <p><strong>Infant with facial port-wine stain in the ophthalmic (V1) territory + seizures + neurological deficit or developmental delay<\/strong> \u2192 Sturge-Weber syndrome \u2192 pediatric neurological emergencies \u2192 MRI of the brain with gadolinium + EEG + fundus examination + intraocular pressure \u2192 multidisciplinary management (neurology + ophthalmology + dermatology).<\/p>\n <p><strong>Patient with recurrent epistaxis, mucosal telangiectasias, and a family history of pulmonary or cerebral AVMs.<\/strong> \u2192 suggest hereditary hemorrhagic telangiectasia (HHT) \u2192 risk of paradoxical stroke due to pulmonary arteriovenous malformation (AVM) \u2192 semi-urgent thoracic CT + brain MRI + contrast echocardiogram \u2192 if pulmonary AVM confirmed: endovascular embolization without delay.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron doctors evaluate cutaneous vascular lesions, differentiate between benign lesions (cherry angioma, physiological spider angioma) and forms requiring specialized investigation or treatment, prescribe appropriate investigations (liver function tests if multiple spider angiomas, ophthalmological and neurological assessments if V1 facial port-wine stain), and refer to competent specialists (dermatologists, pediatricians, vascular surgeons). Consultations are available at several service points in Quebec and via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is provided for informational purposes only and does not replace the advice of a doctor or specialist. Any vascular anomaly in an infant or child, or any rapidly evolving lesion or one associated with systemic symptoms, should be evaluated by a qualified healthcare professional.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Angiome : types, diagnostic et traitement | Clinique Omicron Dermatologie & Chirurgie vasculaire & P\u00e9diatrie & M\u00e9decine de famille Angiome Le terme \u00ab angiome \u00bb d\u00e9signe un groupe h\u00e9t\u00e9rog\u00e8ne de tumeurs b\u00e9nignes ou de malformations des vaisseaux sanguins et lymphatiques. La classification moderne, propos\u00e9e par l’ISSVA (International Society for the Study of Vascular Anomalies) en… <a href=\"https:\/\/cliniqueomicron.ca\/en\/angiome\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Hemangioma: types, diagnosis, and treatment | Omicron Clinic<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Angiome Brossard | Traitement & \u00c9valuation | Clinique Omicron","_metasync_otto_description":"Un angiome est une tumeur b\u00e9nigne des vaisseaux sanguins ou lymphatiques. Angiome rubis, h\u00e9mangiome, angiome plan, angiome araign\u00e9e, laser et traitement au Q...","_metasync_otto_keywords":"","_metasync_otto_og_title":"","_metasync_otto_og_description":"Un angiome est une tumeur b\u00e9nigne des vaisseaux sanguins ou lymphatiques. Angiome rubis, h\u00e9mangiome, angiome plan, angiome araign\u00e9e, laser et traitement au Q...","_metasync_otto_twitter_title":"Angiome : types, diagnostic et | Brossard | Clinique Omicron","_metasync_otto_twitter_description":"Un angiome est une tumeur b\u00e9nigne des vaisseaux sanguins ou lymphatiques. Angiome rubis, h\u00e9mangiome, angiome plan, angiome araign\u00e9e, laser et traitement au Q...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Angiome : types, diagnostic et traitement | Clinique Omicron","_aioseo_description":"Un angiome est une tumeur b\u00e9nigne des vaisseaux sanguins ou lymphatiques. 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\n\t\t\t\t\t\n\n\n\n\nHemangioma: types, diagnosis, and treatment | Omicron Clinic<\/title>\n<meta name=\"description\" content=\"A hemangioma is a benign tumor of the blood or lymph vessels. Cherry angioma, hemangioma, port-wine stain, spider angioma, laser, and treatment in Quebec.\">\n<meta name=\"keywords\" content=\"angiome traitement, angiome rubis, h\u00e9mangiome nourrisson, angiome plan, angiome araign\u00e9e, angiome stellaire, angiome laser, angiome cutan\u00e9, angiome Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap*{font-family:'Poppins',sans-serif;box-sizing:border-box}\n.co-wrap{max-width:1100px;margin:0 auto;padding:30px 0 60px}\n.co-label{font-family:'Cinzel',serif;font-size:14px;font-weight:bold;letter-spacing:1px;text-transform:uppercase;color:#4D6577;margin-bottom:14px;display:block}\n.co-wrap h1{font-size:32px;font-weight:500;color:#323C52;margin:0 0 22px;line-height:1.2}\n.co-intro{font-size:16px;line-height:1.75;color:#4D6577;margin-bottom:36px;padding-bottom:32px;border-bottom:1px solid rgba(77,101,119,.2)}\n.co-wrap h2{font-size:20px;font-weight:600;color:#323C52;margin:32px 0 12px}\n.co-wrap p{font-size:15px;color:#4D6577;line-height:1.7;margin-bottom:14px}\n.co-list{list-style:none;padding:0;margin:12px 0 24px}\n.co-list li{font-size:15px;color:#4D6577;padding:10px 14px 10px 38px;margin-bottom:8px;border-radius:6px;position:relative;background:rgba(77,101,119,.06);border-left:3px solid #4D6577}\n.co-list li::before{content:\"\u2713\";position:absolute;left:12px;font-weight:700;color:#4D6577}\n.co-table{width:100%;border-collapse:collapse;margin:14px 0 22px;font-size:14px;border-radius:8px;overflow:hidden;table-layout:fixed}\n.co-table thead tr{background:#323C52;color:#fff}\n.co-table thead th{padding:11px 16px;text-align:left;font-weight:600;font-size:13px}\n.co-table tbody tr:nth-child(even){background:rgba(77,101,119,.06)}\n.co-table tbody tr:nth-child(odd){background:#fff}\n.co-table td{padding:10px 16px;color:#4D6577;border-bottom:1px solid rgba(77,101,119,.12);font-size:14px;vertical-align:top}\n.co-table td:first-child{font-weight:600;color:#323C52}\n.co-infobox{display:flex;gap:12px;background:rgba(77,101,119,.06);border-radius:8px;border-left:4px solid #4D6577;padding:14px 18px;margin:18px 0 28px;font-size:14px;color:#4D6577;line-height:1.65}\n.co-infobox .ico{font-size:18px;flex-shrink:0}\n.co-urgence{background:#fff8f8;border-left:5px solid #c0392b;border-radius:6px;padding:20px 26px;margin:24px 0 32px}\n.co-urgence .co-urgence-titre{font-size:13px;font-weight:700;color:#c0392b;letter-spacing:1.5px;text-transform:uppercase;margin-bottom:10px}\n.co-urgence p{color:#5a2020;font-size:14px;margin:0 0 10px;line-height:1.7}\n.co-urgence p:last-child{margin-bottom:0}\n.co-disclaimer{font-size:13px;color:#8a9aaa;font-style:italic;border-top:1px solid rgba(77,101,119,.15);padding-top:24px;margin-top:40px;line-height:1.6}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Dermatology & Vascular Surgery & Pediatrics & Family Medicine<\/span>\n <h1>Angioma<\/h1>\n\n <div class=\"co-intro\">\n The term \u00abangioma\u00bb refers to a heterogeneous group of benign tumors or malformations of the blood and lymphatic vessels. The modern classification, proposed by ISSVA (International Society for the Study of Vascular Anomalies) in 1996 and revised in 2018, basically distinguishes two main categories: vascular tumors (with active cell proliferation - infantile hemangiomas, congenital hemangiomas, tufted angiomas, hemangioendotheliomas) and vascular malformations (static structural anomalies without cell proliferation - capillary, venous, arteriovenous, lymphatic or mixed malformations). This distinction is clinically essential, as it determines prognosis and therapeutic strategy: infantile hemangiomas have an active growth phase followed by spontaneous involution, whereas vascular malformations persist and evolve with the patient. In everyday family practice, the most frequently encountered lesions are ruby angioma (senile hemangioma - a small, bright red lesion, benign and extremely common in adults over the age of 30), spider or stellate angioma (associated with cirrhosis or pregnancy), infantile hemangioma (most common vascular tumor in children - 4 to 10 % of infants) and plano angioma (capillary malformation - congenital wine stain). Treatment varies considerably according to type: from simple monitoring (asymptomatic ruby angioma), to oral propranolol (complicated infantile hemangioma), to pulsed dye laser (PDL) or Nd:YAG laser (plano angioma, symptomatic ruby angioma), to surgery or embolization for extensive or dangerous forms.\n <\/div>\n\n <h2>Classification, types, and pathophysiology<\/h2>\n <ul class=\"co-list\">\n <li><strong>Classification ISSVA 2018 and Pathophysiology of Vascular Anomalies<\/strong> international reference classification (ISSVA 2018 - update of Mulliken and Glowacki 1982 classification): category 1 - vascular tumors (active endothelial cell proliferation): infantile hemangioma (IH): most frequent vascular tumor of childhood + growth phase + involution phase \u2192 GLUT-1 positive (specific immunohistochemical marker - North 2000 - Microcirculation) + Rapidly Involuting Congenital Hemangioma (RICH): present at birth + involution in 12-14 months + GLUT-1 negative + Non-Involuting Congenital Hemangioma (NICH): persists throughout life + GLUT-1 negative + Partially Involuting Congenital Hemangioma (PICH) + Tufted Angioma + Kapositic Hemangioendothelioma (KHE) : rare + associated with Kasabach-Merritt phenomenon (thrombocytopenia + DIC + microangiopathic hemolytic anemia \u2192 significant mortality) \u2192 treatment with vincristine + sirolimus \u2192 category 2 - vascular malformations (structural anomalies - no active proliferation): capillary malformations (CM): plane angioma (port-wine stain - nevus flammeus) + telangiectasias + spider angioma + arteriovenous malformations (AVM): abnormal connection between arteries and veins without intermediate capillary bed \u2192 high-velocity flow \u2192 progressive \u2192 expansion under the effect of hormones + trauma + pregnancy + venous malformations (MV): slow flow \u2192 local thrombosis + pain + thrombophlebitis + lymphatic malformations (ML): former \u00ablymphangioma\u00bb \u2192 lymphatic cyst + neonatal hygroma colli \u2192 mixed malformations (capillaro-venous + capillaro-lymphatic + etc.).); pathophysiology according to type: infantile hemangiomas: cellular origin controversial - placental hypothesis dominant : Barn\u00e9s 2005 - Placenta: placental endothelial stem cells (GLUT-1+) \u2192 migration in utero \u2192 VEGF-dependent proliferation (vascular endothelial growth factor) in the first months of life \u2192 VEGF + IGF-2 + bFGF \u2192 proliferation \u2192 then apoptosis-mediated involution + increased TGF-\u03b2 + reduced VEGF + HI risk factors: prematurity (75 years \u2192 genetic factors + sun exposure + immunosuppression + pregnancy + spider angioma (angiome stellaire - spider angioma - spider nevus): dilated central arteriole + radiating capillaries \u2192 reddens at central pressure + whitens \u2192 origin: hyperoestrogenism (pregnancy + estroprogestogenic contraceptives + hepatic cirrhosis) + spider angioma \u2192 clinical sign of advanced chronic liver disease + Foutch 1988 - American Journal of Gastroenterology: >5 spider angiomas \u2192 significant association with cirrhosis and portal hypertension<\/li>\n <li><strong>Clinical Presentation of the Main Types of Angiomas:<\/strong> infantile hemangioma (IH) - vascular tumor of infants: epidemiology: 4-10 % of Caucasian infants + premature infants up to 30 % + F\/H = 3:1 \u2192 localizations: head and neck (60 %) + trunk (25 %) + limbs (15 %) + superficial forms (formerly \u00abstrawberries\u00bb): bright red + relief + well delimited + deep forms (formerly \u00abcavernous hemangioma\u00bb): subcutaneous bluish nodule + mixed forms \u2192 natural evolution in 3 phases: proliferation: birth to 6-9 months \u2192 rapid growth + plateau: 9-12 months \u2192 involution: 1-7 years \u2192 complete involution in 50 % of cases at 5 years + 70 % at 7 years + residual sequelae in 20-40 % of cases (fibrosis + telangiectasias + flaccid skin - especially if HI \u22652 cm) \u2192 Leaute-Labreze 2008 - NEJM : discovery of the effect of propranolol (non-selective beta-blocker) in the treatment of complicated HI \u2192 therapeutic revolution \u2192 complicated HI requiring active treatment (15-20 % of HI): periorbital location (risk of amblyopia) + nasal location (Cyrano - risk of permanent distortion) + labial location (risk of scarring + functional discomfort) + ulcerated HI (pain + superinfection) + extensive facial segmental HI (risk of PHACE syndrome : Posterior fossa anomalies + Facial hemangiomas + Arterial + Cardiovascular anomalies + Eye + Sternal\/Endocrine anomalies) + Subglottic HI (stridor + respiratory distress) + Multiple hepatic HI (hypothyroidism + shunt heart failure) + HI >5 cm (risk of LUMBAR or PELVIS syndrome - spinal dysraphism + anal imperforation + genitourinary anomalies) ; angioma planus (capillary malformation - port-wine stain) : present from birth + pink to dark red macule + often unilateral + geographic contours + frequent facial localization (V1\/V2 territory of trigeminal) \u2192 darkens + thickens with age + may develop nodules + complications: glaucoma (if V1 + periorbital) + Sturge-Weber syndrome (4 % of V1 facial plane angiomas) \u2192 cerebral MRI + fundus recommended if plane angioma in ophthalmic territory + Klippel-Trenaunay: lower limb plane angioma + varicose veins + limb hypertrophy \u2192 clinical diagnosis; ruby angioma (senile hemangioma \/ cherry angioma): bright red to purple papule or macule + 1-5 mm + smooth surface + well delimited + whitens on incomplete vitropression (vascular flow) + preferential location: trunk + arms + shoulders + increases in number with age + benign + no malignant degeneration + clinical diagnosis (dermoscopy: homogeneous red lacunae separated by whitish septa - \u00abred globules\u00bb in dermoscopy) \u2192 treatment if cosmetic discomfort or post-traumatic bleeding; spider angioma (spider nevus): red punctiform central arteriole + 0.5-1 cm radiating capillaries + clears on central compression + localizations: face + d\u00e9collet\u00e9 + upper limbs + children: physiological in small numbers + adults: >5 spider angiomas \u2192 liver check-up + pregnancy: physiological (hyperoestrogenism) \u2192 post-partum regression; essential telangiectasias: permanent dilatations of small superficial vessels (capillaries + venules) + face (couperose) + legs (reticular veins + telangiectasias) + Rendu-Osler-Weber (hereditary hemorrhagic telangiectasia - HHT) : ENG (endoglin) or ACVRL1 (ALK1) mutation + autosomal dominant \u2192 mucosal + digestive telangiectasias + recurrent epistaxis + pulmonary + hepatic + cerebral AVMs \u2192 to be evoked if epistaxis + unexplained hemoptysis + iron-deficiency anemia without obvious cause \u2192 family genetic screening<\/li>\n <\/ul>\n\n <h2>Diagnosis, treatment and follow-up<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:200px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Type \/ intervention<\/th><th>Diagnostic and therapeutic modalities<\/th><th>Evidence and recommendations<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Infantile hemangioma (IH) \u2014 diagnosis and treatment<br><small style=\"font-weight:400;color:#7a8fa0;\">GLUT-1 \u2014 propranolol \u2014 timolol \u2014 corticosteroids \u2014 laser \u2014 PHACE \u2014 Ulcerated Hemangioma \u2014 pediatric follow-up<\/small><\/td>\n <td>Diagnosis of HI: clinical in the vast majority of cases + no biopsy necessary if typical presentation \u2192 ultrasound-Doppler (high flow - intra-lesional arterial flow) if doubt \u2192 MRI if deep HI + undetermined subcutaneous localization + suspicion of PHACE syndrome + extensive segmental HI \u2192 GLUT-1 immunohistochemistry if biopsy performed \u2192 GLUT-1 positive = HI (excellent sensitivity and specificity - North 2000 - Microcirculation) \u2192 to be distinguished from: congenital hemangioma (RICH\/NICH - GLUT-1 negative) + venous malformation + tufted angioma + kaposiform hemangioendothelioma \u2192 systemic workup if multiple hepatic HI (>5 skin lesions \u2192 hepatic HI screening by ultrasound) \u2192 TSH dosage (hypothyroidism by overexpression of iodothyronine deiodinase type 3 by HI cells) \u2192 risk of profound hypothyroidism + neurodevelopmental delay ; oral propranolol - reference treatment for complicated ICH (since Leaute-Labreze 2008 - NEJM): mechanism: vasoconstriction + reduction in VEGF and bFGF expression + promotion of apoptosis of HI endothelial cells \u2192 Leaute-Labreze 2015 - NEJM (PRIDE trial): international multicenter RCT n=456 infants \u2192 propranolol 3 mg\/kg\/d \u00d7 6 months vs placebo \u2192 success at 24 weeks: 60 % vs 4 % \u2192 worldwide standard of care \u2192 initiation scheme: in hospital or specialized consultation \u2192 ECG + blood glucose before initiation + cardiac workup if pathology suspected + contraindications: PHACE with severe arterial abnormalities (risk of stroke due to vasoconstriction) + asthma + AV block + bradycardia + neonatal hypoglycemia \u2192 dose: 1 mg\/kg\/d \u00d7 1 week \u2192 2 mg\/kg\/d \u00d7 1 week \u2192 3 mg\/kg\/d (maximum dose) \u2192 monitoring: HR + BP + blood glucose when dose is increased \u2192 duration: 6 months (generally until age 12-15 months) \u2192 adverse effects: hypoglycemia (take with meals - fasting to be avoided) + bradycardia + bronchospasm + sleep disorders \u2192 recurrence on discontinuation: 10-25 % \u2192 resumption of propranolol \u2192 timolol gel 0.5 % ophthalmic topical use: alternative to oral propranolol for localized superficial IH + superficial periorbital IH \u2192 P\u00fcttgen 2016 - JAMA Dermatology: timolol gel 0.5 % \u00d7 2\/d \u2192 partial to complete response in 60-70 % of superficial thin IH \u2192 low but not zero systemic absorption \u2192 systemic corticoids (prednisone 2-3 mg\/kg\/d): 2nd-line option if propranolol contraindicated or in combination \u2192 recognized efficacy but adverse effects (hypertension + Cushing's + growth retardation) \u2192 pulsed dye laser (PDL 585\/595 nm): treatment of residual post-involution sequelae + telangiectasias + very thin superficial HI in involution phase \u2192 not very effective on thick HI in growth phase \u2192 ulcerated HI: local care (oily dressings + vaseline + oily tulle) + oral propranolol (accelerates healing of ulceration) + topical antibiotic therapy if superinfection (fusidic acid) + analgesia (paracetamol + oral sucrose in infants) + PDL laser if persistent<\/td>\n <td>Key data on propranolol in IH: Leaute-Labreze 2008 - NEJM: initial case report \u2192 propranolol 2 mg\/kg\/d \u2192 rapid, dramatic regression of IH \u2192 chance discovery \u2192 therapeutic revolution \u2192 Leaute-Labreze 2015 - NEJM (PRIDE trial): RCT n=456 \u2192 propranolol 3 mg\/kg\/d \u00d7 6 months \u2192 success rate 60 % vs 4 % placebo \u2192 p<0.001 \u2192 worldwide standard of care \u2192 Drolet 2013 - Pediatrics: multicenter cohort \u2192 propranolol \u2192 response from the first weeks \u2192 plateau at 6 months + Solman 2018 - British Journal of Dermatology: meta-analysis \u2192 oral propranolol superior to topical timolol + oral corticosteroids for complicated IH \u2192 consensus indication: localized periorbital + nasal + labial + subglottic + ulcerated + PHACE IH without vascular contraindication; position of Hypertension Canada and pediatric societies: CPS (Canadian Pediatric Society) 2023: propranolol = 1st-line treatment of complicated IH \u2192 initiation by physician specialized in pediatric dermatology or pediatric surgery \u2192 close follow-up for first few weeks + Hoeger 2015 - Journal of the American Academy of Dermatology: algorithm for management of IH \u2192 indications for treatment + contraindications for propranolol + specialized referral criteria<\/td>\n <\/tr>\n <tr>\n <td>Angioma plan \u2014 laser treatment and follow-up<br><small style=\"font-weight:400;color:#7a8fa0;\">PDL \u2014 Nd:YAG \u2014 laser 532 nm \u2014 Sturge-Weber \u2014 glaucoma \u2014 results \u2014 recurrence \u2014 number of sessions<\/small><\/td>\n <td>Planar angioma treatment with vascular laser: reference laser: pulsed dye laser (PDL - Pulsed Dye Laser) 585\/595 nm: principle of selective photolysis (Anderson and Parrish 1983 - Science): the laser is selectively absorbed by oxyhemoglobin (absorption peak at 577-585 nm) \u2192 coagulation of dilated vessels in the dermis \u2192 epidermal sparing \u2192 parameters: wavelength 585 or 595 nm + pulse duration 0.45-40 ms + energy density (fluence) 6-12 J\/cm\u00b2 + spot 5-10 mm \u2192 results: partial to complete whitening in 60-80 % of cases + Renfro 1993 - Journal of the American Academy of Dermatology: PDL \u2192 complete response 15 % + partial response (>50 % improvement) 60 % \u2192 variable results depending on location (central face best response) + thickness (thick angioma \u2192 less good response) + color (pinkish \u2192 better response than dark red or violet) + age (early treatment in infants \u2192 best results - Enjolras 1990 - Pediatrics) \u2192 number of sessions: 5-20 sessions or more depending on response \u2192 spacing: 6-8 weeks \u2192 insufficient results from PDL alone if: very thick angioma (nodules) + dark violet angioma + resistant angioma \u2192 alternatives and complements to PDL: Nd:YAG 1064 nm laser: deeper penetration \u2192 treatment of thick angiomas + resistant to PDL + PDL + Nd:YAG combination: better response for resistant angiomas + KTP (potassium-titanyl-phosphate) 532 nm laser: effective on telangiectasias and small flat angiomas + IPL (Intense Pulsed Light): intense pulsed light - less effective than PDL for flat angiomas, but useful for diffuse rosacea + Nd:YAG 1064 nm long pulse: treatment of choice for venous malformations + deep angiomas; eye protection mandatory (leaded glasses or eye cones) if periorbital treatment + local or general anesthesia in infants and children; post-laser care: ecchymoses (purpura) for 10-14 days (unavoidable with PDL - photolysis of intravascular red blood cells) + erythema + edema \u2192 local care: vaseline + avoid the sun 4-6 weeks + SPF 50+ sunscreen \u2192 post-inflammatory hyperpigmentation (dark skin - Fitzpatrick IV-VI): increased risk \u2192 test on a small area \u2192 recurrence after treatment: frequent (neoformed vessels) \u2192 maintenance sessions \u2192 long-term results: whitening maintained in 50-70 % of cases at 5 years if early and complete treatment; Sturge-Weber syndrome - multidisciplinary management: systematic screening: planar angioma in ophthalmic territory (V1) \u2192 cerebral MRI with gadolinium (leptomeningeal angioma) + fundus + intraocular pressure (glaucoma) + EEG + neuropsychological assessment \u2192 Comi 2011 - Neurology: MRI + planar angioma V1 \u2192 leptomeningeal angioma in 8-26 % of cases depending on laterality \u2192 treatment: aspirin 3-5 mg\/kg\/d (prophylaxis of ischemic strokes related to stasis in leptomeningeal angioma) + antiepileptics (comitiality) + glaucoma: topical beta-blockers + trabeculectomy if refractory + early PDL laser (as early as the first months) for planar angioma \u2192 better results than offline<\/td>\n <td>Selective photolysis - physical foundations of laser processing : Anderson and Parrish 1983 - Science: theory of selective photolysis \u2192 wavelength selectively absorbed by chromophoric target (oxyhemoglobin) \u2192 pulse duration less than thermal relaxation time of target vessel \u2192 sparing of adjacent tissue \u2192 physical basis of all vascular lasers \u2192 Tan 1992 - Archives of Dermatology: PDL optimized for pediatric planar angiomas \u2192 best results if initiated early (before 1 year) + Renfro 1993 - JAAD: PDL results in planar angiomas \u2192 complete whitening 15 % + partial 60 % over 8-10 sessions \u2192 localization + depth-dependent efficacy + Nguyen 2012 - Lasers in Surgery and Medicine: PDL vs Nd:YAG in resistant planar angiomas \u2192 superior combination + Rohrer 2010 - Dermatologic Surgery: IPL vs PDL \u2192 superior PDL for planar angiomas; treatment of glaucoma associated with Sturge-Weber syndrome: Sujansky 1993 - American Journal of Medical Genetics: prevalence of glaucoma in SWS: 30-70 % \u2192 congenital or juvenile glaucoma + medical treatment (beta-blockers + carbonic anhydrase inhibitors) then surgical if refractory + Comi 2011 - Neurology: early MRI recommended in any child with V1 planar angioma \u2192 presence of leptomeningeal angioma \u2192 predictive factor for neurological severity + aspirin + early neurological management<\/td>\n <\/tr>\n <tr>\n <td>Cherry angiomas and spider angiomas \u2014 treatment and clinical significance<br><small style=\"font-weight:400;color:#7a8fa0;\">Laser \u2014 electrocoagulation \u2014 cryotherapy \u2014 liver function test \u2014 pregnancy \u2014 couperose \u2014 IPL<\/small><\/td>\n <td>Ruby angioma - management: therapeutic abstention justified if asymptomatic (benign lesion + no malignant potential) \u2192 indications for treatment: aesthetic discomfort + repeated bleeding (rubbing or shaving trauma) + troublesome localization (finger + face); treatment options: pulsed dye laser (PDL 595 nm): 1st intention if lesion <3 mm \u2192 one to two sessions \u2192 KTP 532 nm laser: very effective for flat + small lesions \u2192 Nd:YAG 1064 nm long pulse laser: for larger or deep ruby angiomas + electrocoagulation (monopolar electrosurgery): classic in-office treatment \u2192 fine needle + high-frequency current \u2192 coagulation of the central arteriole \u2192 high efficacy on small lesions \u2192 risk of scarring if too intense \u2192 advantage: accessible + inexpensive + without laser equipment \u2192 liquid nitrogen cryotherapy: less effective than laser or electrocoagulation for ruby angiomas \u2192 risk of hypopigmentation on dark skin \u2192 may leave a white scar \u2192 IPL (intense pulsed light): effective for diffuse multiple ruby angiomas (trunk + shoulders) \u2192 single-session surface treatment of large areas; couperose (erythematotelangiectatic rosacea) and facial telangiectasias: IPL + PDL + KTP laser \u2192 very effective for facial telangiectasias + Nd:YAG laser for reticular leg veins (1-3 mm) + foam sclerosis (polidocanol) for varicose veins and telangiectasias of the lower limbs + fine electrocoagulation on isolated nasal telangiectasias; spider angioma - clinical significance and management: in children: often physiological + in small numbers (<5) + disappears spontaneously before puberty \u2192 no systematic workup if 5 + outside pregnancy \u2192 systematic liver workup: ASAT + ALAT + GGT + PAL + bilirubin + albumin + PT + CBC (thrombocytopenia \u2192 portal hypertension) \u2192 echo-abdominal if workup abnormal \u2192 Foutch 1988 - American Journal of Gastroenterology: >5 spider angiomas \u2192 sensitivity 75 % + specificity 84 % for cirrhosis or severe liver disease \u2192 pregnancy: physiological + regression within 3 months postpartum \u2192 estroprogestative contraceptives: partial regression on discontinuation \u2192 treatment if persistent or cosmetically bothersome: PDL or KTP laser on the central arteriole \u2192 one session often sufficient + fine electrocoagulation of the central arteriole \u2192 immediate efficacy \u2192 slight scarring possible if too intense; hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber - HHT): Cura\u00e7ao diagnostic criteria (Shovlin 2000 - American Journal of Medical Genetics): recurrent epistaxis + mucosal and cutaneous telangiectasias + visceral AVMs (pulmonary + hepatic + cerebral) + 1st-degree family history \u2192 HHT certain if 3 criteria + probable if 2 + improbable if 1 \u2192 screening for visceral AVMs: thoracic CT (pulmonary AVMs \u2192 risk of paradoxical stroke + cerebral abscess) + cardiac echo with contrast (right-left shunt) + cerebral MRI (cerebral AVMs) + hepatic angioscan (hepatic AVMs - high-flow heart failure) \u2192 HHT treatment: bevacizumab (anti-VEGF) \u2192 reduction of epistaxis (Dupuis-Girod 2012 - JAMA) + thalidomide \u2192 embolization of pulmonary AVMs + embolization or surgery of cerebral AVMs <\/td>\n <td>Data on treatment efficacy for ruby and spider angiomas: Sommer 2002 - Dermatologic Surgery: PDL vs electrocoagulation for ruby angiomas \u2192 PDL superior in terms of aesthetic results + less scarring \u2192 electrocoagulation: comparable efficacy but slightly higher scar rate \u2192 both effective in daily practice + Hedelund 2006 - Lasers in Medical Science: KTP 532 nm laser \u2192 highly effective for ruby angiomas and facial telangiectasias \u2192 excellent results in 1-2 sessions + Goldberg 2011 - Dermatologic Surgery: IPL + multiple angiomas + rosacea \u2192 improvement in 70-80 % of cases \u2192 less precise than PDL on individual lesions but useful for extensive surfaces; HHT - therapeutic data: Dupuis-Girod 2012 - JAMA: RCT bevacizumab IV in HHT + epistaxis \u2192 significant reduction in duration and frequency of epistaxis \u2192 low NNT \u2192 bevacizumab = validated option in severe HHT + Faughnan 2011 - Annals of Internal Medicine: HHT guidelines \u2192 systematic screening for pulmonary AVMs by chest CT recommended in any HHT patient from diagnosis \u2192 embolization if AVM >3 mm \u2192 reduction in paradoxical strokes and brain abscesses by 80 %<\/td>\n <\/tr>\n <tr>\n <td>Complex vascular malformations \u2014 multidisciplinary diagnosis and management<br><small style=\"font-weight:400;color:#7a8fa0;\">MAV \u2014 venous malformation \u2014 lymphatic \u2014 KHE \u2014 Kasabach-Merritt \u2014 sirolimus \u2014 embolization \u2014 surgery<\/small><\/td>\n <td>Cutaneous and subcutaneous arteriovenous malformations (AVMs): clinical presentation: warm pulsatile mass + palpable quivering + systolic murmur on auscultation + local hyperthermia + distal ischemia if vascular steal + high-flow heart failure if voluminous \u2192 evolution: progressive (worsening under hormones + trauma + pregnancy + incomplete exeresis attempt \u2192 recruitment of new vessels) \u2192 Schobinger classification (1990 - Seminars in Vascular Surgery): stage I (quiescence): pinkish + warm + symptomless AV arteriole \u2192 stage II (expansion): pulsation + tremor + varicosities \u2192 stage III (destruction): ulceration + bleeding + pain + osteolysis if bony \u2192 stage IV (decompensation): heart failure + diagnosis: MRI with gadolinium (arterial flow-void) + angioscanner \u2192 conventional angiography: gold standard before embolization \u2192 treatment: endovascular embolization (feeder arteries) + surgical excision within 24-72h post-embolization \u2192 excision alone or embolization alone \u2192 almost certain recurrence + contraindicated injection of sclerosant alone \u2192 sirolimus (mTOR inhibitor): effective in complex AVMs + Parkes-Weber syndrome \u2192 Venot 2018 - Nature: sirolimus \u2192 lesion reduction in PIK3CA-related overgrowth spectrum (PROS) \u2192 somatic PIK3CA mutations \u2192 alpelisib treatment (PI3K inhibitor) + cerebral AVMs: see neurosurgery \/ interventional neuroradiology; venous malformations (VMs): presentation: bluish mass + compressible + non-pulsatile + increases in declive position + painful on pressure \u2192 phleboliths (round calcifications) = pathognomonic + localized intravascular coagulopathy (localized DIC - fibrin + elevated D-dimers) in extensive forms \u2192 risk of VTE + diagnosis: T2 MRI (hypersignal) + echo-Doppler (low flow) + treatment: percutaneous ethanol or polidocanol sclerotherapy + intravascular 1064 nm Nd:YAG laser (EVLT - endovenous laser treatment) + surgical excision if localized + sirolimus (rapamycin) in extensive or complex forms : Hammer 2018 - Pediatric Blood and Cancer: sirolimus \u2192 reduction in coagulopathy + volume + pain in complex venous malformations; lymphatic malformations (ML): presentation: macrocystic (large logettes - former \u00abcystic lymphangioma\u00bb) + microcystic (superficial vesicles) + mixed \u2192 frequent localization: neck (neonatal hygroma colli) + axilla + mediastinum + tongue + orbit \u2192 prenatal diagnosis possible (hygroma colli \u2192 T21 + Turner to be excluded) \u2192 treatment: percutaneous sclerotherapy with OK-432 (inactivated streptococcus) or doxycycline + surgical resection + sirolimus: reduction of complex MLs (Adams 2016 - Pediatrics); kaposiform hemangioendothelioma (KHE) and Kasabach-Merritt phenomenon: KHE = childhood vascular tumor + intratumoral platelet resorption \u2192 profound thrombocytopenia + DIC + microangiopathic hemolytic anemia \u2192 mortality 10-30 % without treatment \u2192 treatment: sirolimus (rapamycin) - Kai 2014 - Pediatrics: sirolimus 0.8 mg\/m\u00b2\/d \u2192 resolution of Kasabach-Merritt phenomenon in 80-90 % of cases \u2192 current gold standard \u2192 corticosteroids + vincristine as 2nd-line treatment if sirolimus insufficient; reference center for vascular anomalies: complex forms \u2192 refer to a specialized multidisciplinary center: CHU \u2192 team: dermatologist + vascular surgeon + interventional radiologist + hematologist + neurologist depending on involvement <\/td>\n <td>Data on sirolimus in complex vascular anomalies: Venot 2018 - Nature: sirolimus + PIK3CA mutations (PROS - PIK3CA-related overgrowth spectrum) \u2192 reduction of vascular lesions + functional improvement \u2192 PIK3CA mutations found in infantile hemangiomas + planar angiomas + AVMs + CLOVES syndrome + Kai 2014 - Pediatrics: sirolimus in KHE + Kasabach-Merritt \u2192 resolution of thrombocytopenia in 80-90 % \u2192 sirolimus = standard of care in KHE \u2192 Hammer 2018 - Pediatric Blood and Cancer: sirolimus in complex venous malformations \u2192 significant reduction in coagulopathy + volume + pain \u2192 Adams 2016 - Pediatrics: sirolimus in lymphatic malformations + clinical improvement in 85 % of cases; Schobinger 1990 - Seminars in Vascular Surgery: classification of AVMs into 4 stages \u2192 guides therapeutic decisions + fundamental precautions in AVMs: never perform incomplete excision alone without prior embolization \u2192 certain aggravation + recruitment of new arterial pedicles \u2192 Rosen 2009 - Seminars in Interventional Radiology: embolization + surgery within 48h \u2192 better results than delayed surgery<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span><strong>Vascular tumor or vascular malformation: a clinically essential distinction:<\/strong> Infantile hemangiomas (vascular tumors) have a growth phase and then spontaneously involute\u2014the majority do not require treatment. Vascular malformations (port-wine stains, venous malformations, AVMs) do not involute and evolve with the patient. A facial port-wine stain in the V1 territory requires screening for Sturge-Weber syndrome. More than 5 spider angiomas in a non-pregnant adult warrant hepatic evaluation. Complicated infantile hemangiomas (periorbital, nasal, ulcerated, subglottic) should be treated rapidly with oral propranolol under specialized supervision.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations Requiring Urgent Medical Attention or Emergency Room Visit<\/div>\n <p><strong>Infant with rapidly growing peri-orbital, nasal, or labial infantile hemangioma, or with stridor<\/strong> -> Functional or life risk -> Urgent consultation with pediatric dermatology or pediatric surgery -> Immediate initiation of oral propranolol -> Subglottic location: risk of airway obstruction -> Pediatric emergency if stridor + respiratory distress.<\/p>\n <p><strong>Infant or child with large hemangioma + thrombocytopenia + DIC + hemolytic anemia (pallor + jaundice + purpura)<\/strong> \u2192 Kasabach-Merritt phenomenon on kaposiform hemangioendothelioma \u2192 pediatric hematologic emergency \u2192 hospitalization in a specialized center \u2192 sirolimus + corticosteroids + vincristine according to protocol \u2192 mortality 10\u201330 % without treatment.<\/p>\n <p><strong>Infant with facial port-wine stain in the ophthalmic (V1) territory + seizures + neurological deficit or developmental delay<\/strong> \u2192 Sturge-Weber syndrome \u2192 pediatric neurological emergencies \u2192 MRI of the brain with gadolinium + EEG + fundus examination + intraocular pressure \u2192 multidisciplinary management (neurology + ophthalmology + dermatology).<\/p>\n <p><strong>Patient with recurrent epistaxis, mucosal telangiectasias, and a family history of pulmonary or cerebral AVMs.<\/strong> \u2192 suggest hereditary hemorrhagic telangiectasia (HHT) \u2192 risk of paradoxical stroke due to pulmonary arteriovenous malformation (AVM) \u2192 semi-urgent thoracic CT + brain MRI + contrast echocardiogram \u2192 if pulmonary AVM confirmed: endovascular embolization without delay.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron doctors evaluate cutaneous vascular lesions, differentiate between benign lesions (cherry angioma, physiological spider angioma) and forms requiring specialized investigation or treatment, prescribe appropriate investigations (liver function tests if multiple spider angiomas, ophthalmological and neurological assessments if V1 facial port-wine stain), and refer to competent specialists (dermatologists, pediatricians, vascular surgeons). Consultations are available at several service points in Quebec and via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is provided for informational purposes only and does not replace the advice of a doctor or specialist. Any vascular anomaly in an infant or child, or any rapidly evolving lesion or one associated with systemic symptoms, should be evaluated by a qualified healthcare professional.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Angiome : types, diagnostic et traitement | Clinique Omicron Dermatologie & Chirurgie vasculaire & P\u00e9diatrie & M\u00e9decine de famille Angiome Le terme \u00ab angiome \u00bb d\u00e9signe un groupe h\u00e9t\u00e9rog\u00e8ne de tumeurs b\u00e9nignes ou de malformations des vaisseaux sanguins et lymphatiques. La classification moderne, propos\u00e9e par l’ISSVA (International Society for the Study of Vascular Anomalies) en… <a href=\"https:\/\/cliniqueomicron.ca\/en\/angiome\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Hemangioma: types, diagnosis, and treatment | Omicron Clinic<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Angiome Brossard | Traitement & \u00c9valuation | Clinique Omicron","_metasync_otto_description":"Un angiome est une tumeur b\u00e9nigne des vaisseaux sanguins ou lymphatiques. Angiome rubis, h\u00e9mangiome, angiome plan, angiome araign\u00e9e, laser et traitement au Q...","_metasync_otto_keywords":"","_metasync_otto_og_title":"","_metasync_otto_og_description":"Un angiome est une tumeur b\u00e9nigne des vaisseaux sanguins ou lymphatiques. Angiome rubis, h\u00e9mangiome, angiome plan, angiome araign\u00e9e, laser et traitement au Q...","_metasync_otto_twitter_title":"Angiome : types, diagnostic et | Brossard | Clinique Omicron","_metasync_otto_twitter_description":"Un angiome est une tumeur b\u00e9nigne des vaisseaux sanguins ou lymphatiques. Angiome rubis, h\u00e9mangiome, angiome plan, angiome araign\u00e9e, laser et traitement au Q...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Angiome : types, diagnostic et traitement | Clinique Omicron","_aioseo_description":"Un angiome est une tumeur b\u00e9nigne des vaisseaux sanguins ou lymphatiques. 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