Congenital Hemangiomas

Congenital hemangiomas are non-cancerous tumors made up of thickened skin and many thin-walled blood vessels. These blood vessels often have a high rate of blood flowing through them.  

They are present and fully formed at birth (congenital).  Some are diagnosed in utero. 

There is no known cause for congenital hemangiomas. 

There are two types of congenital hemangiomas:

  • Rapidly involuting congenital hemangiomas (RICH) – These lesions decrease in size during the first year of life.  Most are completely gone by 18 months old. The majority will have remaining change to the skin.
  • Noninvoluting congenital hemangiomas (NICH) – These lesions are fully developed at birth and do not decrease in size.

The tumors are most often found on the skin of the head, neck or limbs, but can also occur on the trunk.  Internally, they are most commonly found in the liver. 

They can be flat or may look like a mass sticking up from the skin. They are usually purple / red with a "halo" or lighter colored area around them. 

Usually a diagnosis is made by comparing the medical history with findings from a physical exam. It may be hard to tell some of them apart from infantile hemangiomas or other types of vascular lesions and tumors. The following tests are used to help with the diagnosis:

  • Ultrasonography
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT)

A biopsy is done if there are questions about the diagnosis or if there is a chance of a cancerous growth. A small section of tissue is taken from the lesion and examined by a doctor.

Complications are uncommon, but they occur mostly with RICH, especially if they are large in size, or in an internal organ, such as the liver. Because of their high rate of blood flow, congenital hemangiomas can cause:

  • Congestive heart failure
  • Bleeding problems
  • Skin breakdown

A multidisciplinary pediatric team that specializes in treating hemangiomas should evaluate your child.

The RICH form of congenital hemangiomas do not usually require treatment since they shrink quickly on their own. Decisions to treat these or NICH must be made on an individual basis. The team considers such things as:

  • How well the child can function physically
  • Preventing permanent disfigurement
  • Presence of other complication such as heart failure, ulceration and bleeding

All children with significant congenital hemangiomas should have a thorough exam with follow-up by a doctor. Medications used to treat infantile hemangiomas are usually not effective for congenital hemangiomas.


In most cases, just watching is the best course to follow, especially if the tumor is not hurting a child’s ability to function.

Drug Therapy

The medications typically used to treat infantile hemangiomas may not work for congenital hemangiomas.


Surgery may be needed for complicated congenital hemangiomas, including those in the liver and those that are causing problems with bleeding or heart failure.  At times, an interventional radiologist can block the blood supply to the lesion to improve heart failure.

Last Updated 12/2013