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A 3 month old infant with a “strawberry” red mass on her nose

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3810 (Published 12 June 2014) Cite this as: BMJ 2014;348:g3810
  1. E Charles, medical student1,
  2. C Milroy, consultant paediatric plastic surgeon2,
  3. N K Goldstraw, consultant paediatric dermatologist3,
  4. S Giuliani, consultant paediatric surgeon and senior lecturer1
  1. 1Department of Paediatric and Neonatal Surgery, St George’s Healthcare NHS Trust and University of London, London SW17 0QT, UK
  2. 2Department of Paediatric Plastic Surgery, St George’s Healthcare NHS Trust and University of London, London, UK
  3. 3Department of Paediatric Dermatology, St George’s Healthcare NHS Trust and University of London, London, UK
  1. Correspondence to: S Giuliani stefano.giuliani{at}nhs.net

A 3 month old infant presented to the general practitioner with a “strawberry” red, lobulated, and compressible mass on the tip of her nose (figure). Her nasal cartilage and internal nose did not seem to be affected. The lesion had first been noticed six weeks earlier as a small red spot but had grown quickly and now covered her entire nose. She was otherwise well and had no signs of bleeding or ulceration. The parents were extremely worried and wanted urgent treatment for this lesion.

Questions

  • 1. What is the diagnosis and what is the correct definition of this condition?

  • 2. What other differential diagnoses should be covered in this patient?

  • 3. Should this patient be referred to a tertiary paediatric centre and, if so, why?

  • 4. How would you counsel the parents at the first clinical appointment?

Answers

1. What is the diagnosis and what is the correct definition of this condition?

Short answer

The correct diagnosis for this lesion is infantile haemangioma of the nose in its proliferative phase.

Long answer

Previous terms for this type of lesion include strawberry haemangioma, strawberry naevus, and capillary haemangioma; however, these terms should no longer be used in medical practice. The International Society for the Study of Vascular Anomalies (ISSVA) classification system was issued in 1996 with the aim of establishing a common nomenclature, and it is currently the only system to be widely accepted across the different specialties involved.1 This classification system refers to the original description by Mulliken and Glowacki in 1982 and is based on endothelial characteristics and clinical behaviour.2 It divides vascular anomalies into two main categories: vascular tumours and vascular malformations.3 4

Infantile haemangioma is the most common vascular tumour of infancy, being found in about 5% of infants.5 The incidence is highest in female and premature infants.6 Unlike congenital vascular malformations, this benign lesion is typically not present at …

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