Infantile hemangiomas are the most common benign tumors of infancy, occurring in up to 10% of infants, with up to 50% involving the head and neck. Precursors may be present at birth, evolving into a more classic appearance within the first few months of life. Usually, infantile hemangiomas grow rapidly during the first few weeks of life. This initial proliferative phase typically peaks as early as 2 months of age. This is followed by a steady state lasting months, depending on the hemangioma type, followed by gradual involution over several years, with more than 90% completely involuting by age 10. Although infantile hemangiomas involute with time, residual skin changes such as telangiectasia, scarring, atrophy, and fibrosis persist in up to 30% of lesions after involution is complete.

Lumbosacral infantile hemangioma is associated with a high frequency of spinal dysraphism (defective fusion of the neural tube leading to spinal or bony abnormalities). The best data are retrospective and focus on lesions larger than 2.5 cm in diameter overlying the lumbar or sacral spine. About 50% of lesions this size had associated spinal cord abnormalities including lipomas, tethering, and intraspinal hemangiomas. All of these lesions, possibly reflecting selection bias, had associated spinal dysraphism. Lipomas, tethered spinal cord, and intraspinal hemangiomas were associated with the cutaneous lesions. Port-wine stains are not included.

Syndromes associated with hemangiomas in this region of the body include:

• PELVIS syndrome (perineal hemangioma, extragenital malformations, lipomyelomeningocele, vesicorenal abnormalities, imperforate anus, and skin tag)
• LUMBAR syndrome (lower body hemangioma and other cutaneous defects, urogenital anomalies, ulceration, myelopathy, bony deformities, anorectal malformations, arterial anomalies, and renal anomalies)

Data on the presence of spinal anomalies with smaller hemangiomas and other vascular malformations are sparse and subject to ascertainment bias and incomplete descriptions in some published reports.

Related topics: infantile hemangioma, lumbosacral skin lesion, spina bifida