The treatment of hemangiomas: with special reference to the role of steroid therapy.

Hemangiomas are the most common of all human birth defects. The author has reviewed a 25-year personal experience with treatment of over 1000 patients with a variety of common and rare developmental vascular anomalies. Attention is given to a more useful clinical classification of these disorders. The classification is intended to be helpful in estimating prognosis of the lesions and as a guide to the choice of therapy. Many treatment modalities are evaluated--some successful and some quite disappointing. Surgical excision, irradiation, CO2 freezing, sclerosing agents, cauterization, steroid therapy and watchful waiting are among the treatment methods evaluated. High dose--short course Prednisone therapy has proved to be a major new addition to the treatment of massive juvenile capillary hemangiomas. Numerous misconceptions have appeared in the medical literature. These are noted and a philosophic basis for present day management is suggested for each type angioma. The roles of growth, resolution, histologic picture and sense of deformity are considered in viewing the surgeon's approach to these difficult and challenging problems. Some evidence and speculations are offered as to the etiology, neurogenic influences and physiological dynamics of the various hemangiomas.