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Endgames Picture Quiz

Periocular lesion in an infant

BMJ 2011; 343 doi: (Published 28 November 2011) Cite this as: BMJ 2011;343:d7461
  1. Katie Williams, specialist registrar, ophthalmology1,
  2. Richard Woolf, specialist registrar, dermatology2,
  3. Danny Morrison, consultant paediatric ophthalmic surgeon1
  1. 1Children’s Eye Department, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
  2. 2St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust
  1. Correspondence to: K Williams{at}

A 3 month old girl presented to the dermatology department with an enlarging lesion over the left lateral bridge of her nose (figure). The lesion started to develop three weeks after birth as a small red patch and subsequently grew in size. The lesion extended to the left upper eyelid, with partial obscuration of the line of sight. The girl was born at full term after a normal pregnancy and delivery. She was otherwise well and not taking any regular drugs.


  • 1 What is the diagnosis?

  • 2 What is the natural course of this condition?

  • 3 Should this lesion be treated and, if so, why?

  • 4 What are the treatment options?


1 What is the diagnosis?

Short answer

The development of a superficial capillary haemangioma (strawberry naevus) with associated deep haemangioma in the first few weeks after birth is consistent with an infantile haemangioma.

Long answer

The patient has a superficial haemangioma (strawberry naevus) combined with a deep haemangioma that is causing elevation. Haemangiomas are a type of vascular tumour.1 Infantile haemangiomas are the most common soft tissue tumours of infancy, occurring in 4-10% of infants under 1 year,2 and they generally present as a flat red lesion in the first few weeks after birth. The most likely diagnosis in this case is therefore an infantile haemangioma.

Congenital haemangiomas (present at birth) are less common and are defined as rapidly involuting congenital haemangiomas or non-involuting congenital haemangiomas.1 Neonates with multiple haemangiomas may have diffuse neonatal haemangiomatosis, in which haemangiomas may be present systemically …

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