Article
Oral haemangiomas
I recently commenced work in an Oral Medicine department at a Dental Hospital and it has struck me just how common vascular lesions, in particular haemangioma referrals, are. I would like, therefore, to provide a short review of the intra-oral haemangioma.
A haemangioma is a benign, vascular malformation which is usually a small isolated developmental abnormality.1 They are normally flat lesions which are described as red, red/blue or blue and can occur anywhere within the oral cavity. They are more common on the tongue and lips and, while they are usually asymptomatic, they can bleed with trauma.
Potential differential diagnoses (but not exhaustive) include: varicosity; amalgam tattoo; mucocele; naevi; telangiectasia; melanotic macule; haematoma; eruption cyst; Kaposi sarcoma; and salivary gland tumour. A useful diagnostic tool is the placement of a glass slide to compress a haemangioma; it will blanch and lose its colour.2
Unless there is diagnostic uncertainty, treatment of haemangiomas is not usually indicated and an explanation, along with reassurance, is sufficient. Treatment is reserved for patients with aesthetic concerns, or where the lesion is at risk of repeat trauma likely to induce bleeding, for example a shaving injury. Increasing size may also warrant an excisional biopsy.
Treatment options may include no treatment, spontaneous involution and resolution, excisional biopsy, laser ablation or cryosurgery, as determined by secondary care and on discussion with the patient.
Most importantly, referrals to secondary care are fundamental when there are concerns about the lesion demonstrating any sinister features, or for a second opinion. Of note, within the literature there have been 11 reported cases describing angiosarcomas arising from benign haemangiomas in the absence of irradiation.3 If the patient has aesthetic concerns, or the lesion is vulnerable to repeat trauma, this may also warrant a referral. Finally, for the GDP, the use of a diagnostic glass slide and repeat photographs of the lesion are invaluable diagnostic tools to help in identifying and reviewing an intra-oral haemangioma and may negate a long wait for a referral and reassurance.