Red spots on the skin, tumor or vascular malformation?

Identical in appearance, the tumor and vascular malformation they are totally different pathologies. Although apparently the red spots on the skin may seem the same, the injuries do not correspond to the same type: some may be vascular tumors or hemangiomas and other malformations (cavernous angiomas, planes, etc.). This differentiation is vital to get an adequate treatment, avoiding unnecessary tests.

Vascular lesions are alterations that appear in the blood vessels and are found, especially in the skin. These can be hemangiomas or vascular malformations. Hemangiomas are benign tumors of vascular origin, that is, they are blood vessels (arteries, veins, capillaries) that grow more than normal, but that neither invade other tissues nor degenerate into malignant tumors. Inside they are, generally, like tangles of disordered veins.


In contrast, vascular malformations or flat angiomas are dilated and congested blood capillaries (not tumors).

How and when red spots appear on the skin

These red spots on the skin appear more frequently in premature babies; Nowadays, twin or triplet births have increased a lot, so nowadays it is becoming a serious problem.

These babies weigh a kilo, kilo and a half, two kilos, increasing the rate of hemangiomas to one in ten, although in many cases they disappear in the first weeks of life without any type of treatment. If we exclude these, the frequency in general of the pathological ones is lower, although the rebound in newborns is tremendously significant in our country.


The Hemangiomas appear in almost 1 in 10 newborns and the Malformations affect 4 out of 10. When dealing with lesions of vascular origin, they usually manifest as red spots on the skin. Early detection and diagnosis is very important in order to avoid ineffective treatments or invasive diagnostic tests, since each lesion is treated differently: in tumors, pharmacological treatment predominates, whereas surgical malformations predominate in tumors.

Go to the specialist before a hemangioma

Before the appearance of a hemangioma you have to go to a vascular anomaly specialist. Regardless of where the injury appears, 80% are cutaneous, so it is usually go to the dermatologist and this is the one that guides the family. The first weeks of life are difficult to diagnose, because the lesions are very similar. Therefore, the first step is patience, prudence and tranquility. The normal thing is that it is not something serious. Usually, between the pediatrician and the dermatologist will give the first practical advice.


The difficulty comes when they appear in a critical place: the eye, the nose, the lips, the external genitalia, the perianal margin, etc. In the genital area and the anus they cause discomfort and pain to the child, which is already a reason for therapeutic action. On the face can affect vision, or hinder breastfeeding if it is in the lip, in addition to a greater tendency to ulcerations and be painful.

In these cases, the specialist is forced to have a more aggressive therapeutic action. But if they are not in these locations, the usual thing is to wait and see what happens during the first months of life, starting from the base that we talk about totally benign lesions, that never become malignant and that in very few cases can be a risk to life.

When red spots on the skin disappear

At 60% of children disappear before age 6, 90% before age 9, and 100% before age 10. Depending on the morphological characteristics of the hemangioma, it will leave sequels or not; If it produces ulcerations of the skin, it usually leaves scars. The disappearance of the hemangioma occurs when the arteries and veins that form it are replaced by a fatty tissue, this process being unique in the world of biology.

Hemangiomas, symptom of other diseases

Hemangiomas can be the manifestation of another disease.

1. The hemangiomas of the face they are called segmental and, in almost all cases, have an abnormality of the development of the cranial arteries. Each patient must be studied because they may have epileptic seizures, an aneurysm, etc.

2. Hemangiomas of the perineum They also have internal involvement (area of ​​the buttock, anus, sacrum, the end of the spinal cord), there may be disorders in the development of the nervous system.

3. Hemangiomas that affect the midline of the thorax or, sometimes, those that affect the face with great extension are associated with congenital heart diseases and, sometimes, they can be affected with hypothyroidism. It has also just been discovered that large hemangiomas in the liver produce hypothyroidism.

So, all children who have very large hemangiomas should be checked from the analytical point of view.

The origin of hemangiomas is in the placenta

In recent years, it has been discovered that the origin of the angiomas is in the placenta; now, the specialists have left to study the mechanism by which the cells of the placenta migrate and go to any organ of the body and trigger the hemangioma; why some organs are very affected and why others are not; why it affects the skin and always in significant lines of the face; why there are areas where they never appear, for example, are very rare in the central nervous system, or in the brain.

When and why a hemangioma intervene

- Very large and severe hemangiomas produce serious facial disorders, which lead to difficult schooling.
- They usually come out in the face.
- Children must live with them for 7 or 8 years.
- The treatment protocols are changing. Now they are more aggressive to solve it before schooling.
- The negative effect on the psychological evolution of the child is reflected in the high rates of school failure, since they even disfigure the area where they appear.
- Therefore, for the sake of parents and children, we are currently trying to stop the process before two years and surgically remove it later, even if it is a benign disease.

Vicen Ramón
Advice: Dr. Juan Carlos López Gutiérrez. Coordinator of the congenital vascular anomalies program. Department of Pediatric Surgery. Children's Hospital La Paz.

Video: Difference Between Angioma and Hemangioma


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