Elsevier

The Journal of Hand Surgery

Volume 38, Issue 11, November 2013, Pages 2271-2283
The Journal of Hand Surgery

Current concepts
Congenital and Infantile Skin Lesions Affecting the Hand and Upper Extremity, Part 1: Vascular Neoplasms and Malformations

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Many dermatologic conditions may be present on a newborn infant's upper extremity that can evoke concern for parents and/or primary caregivers. Although the pediatrician typically remains the first care provider, often these children are referred to specialists to diagnose and treat these lesions. Hand surgeons should be familiar with different infantile skin lesions on an upper extremity. Some lesions are best observed, whereas others require treatment with nonoperative measures, lasers, or surgical interventions. A 2-part series is presented to aid the hand surgeon in becoming familiar with these lesions. This part 1 article focuses on vascular neoplasms and malformations. Particular attention is paid to the multiple types of hemangiomas and hemangioendotheliomas, telangiectasias, angiokeratomas, as well as capillary, venous, and lymphatic malformations. Diagnostic tips and clinical photographs are provided to help differentiate among these lesions. In addition, the recommended treatment for each is discussed.

Section snippets

Hemangioma of infancy

Hemangiomas are the most common benign tumors of infancy, with approximately 15% occurring on the extremities.2 Reported incidence rates vary widely, with approximately 1% to 4% of Caucasian infants affected.3, 4 Incidence is greater in infants of Caucasian race, females, premature birth, and after chorionic villus sampling has been performed. A positive family history may be present in up to 10% of cases.2

Hemangiomas of infancy, which can vary greatly in size and location, classically progress

Vascular Malformations

Vascular malformations may be classified as capillary, venous, arterial, lymphatic, or combined. These lesions may expand with the growth of the child or progressive ectasia, but they do not proliferate.32 Similarly, they do not undergo spontaneous resolution.2

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