Article
Response to oral haemangiomas
I write in response to the recent Letter to the Editor entitled ‘oral haemangiomas’ (February 2020). I wish to draw attention to the incorrect, and unfortunately very common, use of the term ‘haemangioma’ to describe what is actually usually a vascular malformation. A true haemangioma is a benign vascular tumour (of which there are many types), most commonly an infantile haemangioma − a vascular tumour that develops in the first few months of life, which then rapidly grows before plateauing, usually resolving before the age of 10 years.
Historically, the term ‘haemangioma’ has been used to describe both vascular tumours and vascular malformations, hence the confusion in the literature, texts and amongst clinicians.
When the term ‘oral haemangioma’ is used, what the clinician is referring to is not a tumour, but usually a vascular malformation. I urge readers to view the easy-to-understand International Society for the Study of Vascular Anomalies Classification1 for clarification on nomenclature; this guidance explains that all vascular lesions should be referred to as vascular anomalies. Vascular anomalies can then be divided into vascular tumours or vascular malformations. Vascular tumours are subdivided into malignant, locally aggressive and benign – where the reader will find haemangiomas. Vascular malformations may be divided into subcategories, depending on which vessel type is predominant (eg capillary, venous, arterio-venous, etc).
As well as blanching beneath a glass slide (emptying sign), clinically important features in assessing vascular anomalies include colour (red or blue/purple), if the lesion has a palpable pulse and if there is dependency (increase in size of the lesion with gravity). This can help the clinician determine if the lesion may be venous or arterial in nature, and therefore ultimately can affect treatment options.
Unfortunately, the term ‘haemangioma’ is commonly mis-used by dentists and those less familiar with vascular lesions. I encourage undergraduates and fully qualified dentists instead to refer to these lesions simply as vascular anomalies or vascular malformations, as when these lesions are referred on to a specialist (particularly OMFS or plastics) the term ‘haemangioma’ means an entirely different thing.
With thanks to Mr Nick Wilson-Jones (Consultant Paediatric Plastic Surgeon, Morriston Hospital, Swansea) for introducing me to the ISSVA classification.