These collections of dilated vessels deep in the dermis and subcutaneous tissue are present at birth. They usually present as bluish or reddish lesions that are cystic, firm, and compressible (A). About 60% to 80% of cavernous hemangiomas undergo spontaneous involution, often with central clearing and fibrosis.
Possible complications include ulceration, infection, and hemorrhage. Giant cavernous hemangiomas (B) may be associated with platelet sequestration, which may lead to intravascular coagulopathy or thrombocytopenia (Kasabach-Merritt syndrome). A palpable thrill or an audible bruit over the lesion suggests the presence of an arteriovenous fistula, which may lead to congestive heart failure.
A strategy of watchful waiting should be followed in most cases. Indications for active intervention include an alarming growth rate, threatening ulceration in areas where serious complications could ensue, interference with vital structures, severe bleeding, congestive heart failure, and life-threatening thrombocytopenia.
If treatment becomes necessary, a course of prednisone, 2 mg/kg/d for 2 weeks, 1 mg/kg/d for another 2 weeks, and 0.5 mg/kg/d for a final 2 weeks, is effective in 30% to 90% of patients. Other modes of treatment include subcutaneous interferon alfa-2a and surgical ablation.