“I want to help clear up the red birthmark my newborn has.”
“I want to know what this lump on my body is and whether it’s anything to worry about.”
Do any of these concerns sound familiar—whether for your child or yourself?
Red birthmarks and red spots may be caused by a skin condition known as a hemangioma. Hemangiomas are classified into six types, each requiring a different approach to treatment.
Because hemangiomas may not resolve on their own, consider consulting a clinic for an evaluation.
This page covers the causes and types of hemangiomas, as well as the treatment options available at our clinic. We also explain how to address red spots that may be hemangiomas, so please read on for more information.
Please note that our clinic does not treat hemangiomas or red birthmarks in children aged 12 or under. In such cases, we will provide a referral to a general hospital.
What Are Hemangiomas and Vascular Malformations? Causes and Symptoms of 6 Types
A hemangioma is an abnormality of blood vessels that presents as a “red birthmark” or red spot. It is a benign growth caused by the dilation or proliferation of blood vessels. Hemangiomas that remain the same size from birth are also referred to as “vascular malformations.”
Hemangiomas are benign tumors arising from the proliferation of vascular endothelial cells, and their pathophysiology is complex (Reference 9). Under the current classification by the International Society for the Study of Vascular Anomalies (ISSVA), vascular anomalies are broadly divided into vascular tumors (hemangiomas) and vascular malformations (Reference 1). Hemangiomas are characterized by a proliferative phase and an involutional phase of endothelial cells, whereas vascular malformations result from congenital structural abnormalities of blood vessels (Reference 2).
Hemangiomas can be classified into six types.
The current standard classification is that of the International Society for the Study of Vascular Anomalies (ISSVA), which broadly divides vascular anomalies into two categories: vascular tumors (which form masses and undergo proliferation and involution) and vascular malformations (structural abnormalities of blood vessels that enlarge with growth) (Reference 1). This classification has enabled more accurate diagnosis and treatment selection.
| Type | Characteristics |
|---|---|
| Port-Wine Stain (Simple Hemangioma) | A flat red birthmark present from birth |
| Strawberry Hemangioma (Infantile Hemangioma) | A raised red mark resembling a halved strawberry |
| Capillary Malformation | A red mark that deepens in color with age |
| Venous Malformation | A growth caused by an abnormality in the venous vessels |
| Arteriovenous Malformation | A growth caused by an abnormality in the arteriovenous vessels |
| Lymphatic Malformation (Lymphangioma) | A growth caused by the accumulation of lymphatic fluid beneath the skin |
The following sections describe the characteristics and treatment options for each type of hemangioma.
1. Port-Wine Stain (Simple Hemangioma) | A Red Birthmark Present from Birth
A port-wine stain is a flat red birthmark that is present from birth.
The depth of color varies from person to person and may darken to a brownish hue with age. As the body grows, the area affected by the birthmark often expands as well.
With the exception of certain cases known as salmon patches, port-wine stains do not disappear on their own, so clinical treatment is required if you wish to have the birthmark removed.
Treatment options for hemangiomas include laser therapy, radiation therapy, and cryotherapy. Laser therapy is often preferred due to its relatively lower risk of side effects.
2. Strawberry Hemangioma (Infantile Hemangioma) | Common in Infants (Not treated at our clinic)
A strawberry hemangioma is a raised red mark that develops on the skin of newborns and young infants.
Its name comes from its resemblance to a halved strawberry pressed against the skin.
The red mark typically grows over a period of about six months. After growth stops, the mark tends to gradually fade and often disappears naturally between the ages of 5 and 10.
Approximately 60% of infantile hemangiomas involute spontaneously by age 5; however, around 10–15% of cases result in functional or cosmetic concerns, making timely treatment important (References 11, 12). In recent years, oral propranolol has become the first-line treatment (Reference 4). Because loose skin or scarring can remain even after the redness resolves, treatment is often recommended.
Laser therapy is the primary treatment used to address strawberry hemangiomas. It may help slow or stop the growth of the hemangioma.
3. Capillary Malformation | Deepens in Color with Age
A capillary malformation is a condition in which the fine capillaries spread across the skin become abnormally numerous and dilated.
It is a red mark that tends to deepen in color with age and may become raised above the skin surface.
Capillary malformations are caused by a congenital abnormality of the capillaries. The condition progresses slowly, with the color gradually deepening and the affected area potentially enlarging over time.
Treatment is carried out using laser therapy or surgical procedures.
4. Venous Malformation | Caused by Venous Abnormalities (Not treated at our clinic)
A venous malformation is a vascular lesion that develops due to an abnormality in the venous vessels.
Veins that normally form smooth channels become distorted in shape, causing swelling and pain in the affected area.
Because the many veins throughout the body vary in shape, the presentation of venous malformations differs from person to person.
For example, the affected vessels may be coiled or multiple veins may be intertwined.
The decision to treat a vascular anomaly is based on a comprehensive assessment of factors including functional impairment, cosmetic concerns, and the wishes of the patient and family (Reference 7). When functional problems are present—such as impaired vision, breathing, or eating—urgent treatment may be indicated. Common treatment options for venous malformations include surgery and sclerotherapy.
Sclerotherapy involves injecting a chemical agent directly into the blood vessel to damage the cells within and cause the vessel to close. By collapsing the affected vessel through sclerotherapy, the venous malformation can be improved. Before the procedure, MRI and imaging studies are typically performed to assess the internal condition of the lesion.
5. Arteriovenous Malformation | Caused by Arteriovenous Abnormalities (Not treated at our clinic)
An arteriovenous malformation (AVM) develops due to an abnormality in the pathway through which blood flows from arteries to veins.
AVMs are believed to be congenital in origin, though the exact cause has not been fully established.
(Reference: Intractable Disease Information Center | Public Interest Foundation for Intractable Disease Medical Research)
When the lesion is small, surgical resection may be possible. However, larger lesions can affect cardiac function, making surgical removal more difficult.
Because AVMs are often progressive, we recommend consulting a clinic promptly before the lesion grows and treatment becomes more challenging.
6. Lymphatic Malformation (Lymphangioma) | A Benign Cyst-Like Growth (Not treated at our clinic)
A lymphangioma is a condition in which fluid-filled sacs containing lymphatic fluid form, resulting in a growth.
The sacs vary in size; those exceeding 1 cm are generally considered large.
Lymphangiomas are benign growths and do not enlarge aggressively or spread to other areas.
However, bleeding may occur within the growth. If blood accumulates inside, the affected area can enlarge rapidly.
Bacterial infection within the growth may also occur, potentially causing high fever. If symptoms worsen, hospitalization and antibiotic treatment may be required.
Lymphangiomas may resolve on their own in a number of cases. Because treatment carries a risk of complications, watchful waiting without active treatment is also a valid option when the patient is asymptomatic.
3 Treatment Options for Hemangiomas
Below is a summary of the main treatment options for hemangiomas and the conditions each addresses.
| Treatment | Applicable Conditions | |
|---|---|---|
| Surgery | Surgical removal of the birthmark or growth | Applicable to many conditions |
| V-Beam Laser | Selectively targets and destroys blood vessels using laser light | ・Port-wine stain ・Strawberry hemangioma (infantile hemangioma) ・Telangiectasia |
| Sclerotherapy | Injection of a specialized agent into the blood vessel | ・Lymphangioma ・Venous malformation |
Hemangiomas can be treated with three main approaches: surgery, V-Beam laser therapy, and sclerotherapy. The appropriate treatment depends on the type of lesion.
The following sections describe the features of each treatment and the conditions it addresses.
1. Surgery
Red birthmarks and growths caused by hemangiomas can be surgically removed.
Because surgery carries risks such as significant bleeding and scarring, it is generally considered a last resort when other treatments have not provided sufficient results.
On the other hand, surgery can address a wide range of conditions and the results may be noticeable from the day of treatment. For example, if residual skin thickening remains after the redness of an infantile hemangioma has resolved, surgical removal may be an option.
2. V-Beam Laser
V-Beam is a treatment that directs laser energy at hemoglobin in the blood to destroy the affected blood vessels.
The device incorporates a cooling system to help minimize skin damage and discomfort, and can generally be performed without anesthesia. The pulsed dye laser (V-Beam) has been shown to achieve an improvement rate of 70–90% for port-wine stains (Reference 14) and has an established role in treating infantile hemangiomas during the proliferative phase (Reference 15). Its 595 nm wavelength is selectively absorbed by hemoglobin, helping to minimize damage to the surrounding tissue.
Laser therapy generally carries a lower risk of long-term side effects compared with other treatment methods. However, V-Beam treatment may cause bruising, resulting in the treated area appearing dark purple or black for a period of time.
For more details on V-Beam, including how it works, the treatment process, and fees, please visit the following page.
V-Beam: Effects, Downtime, and Treating Red Acne Scars & Facial Redness Under Insurance Coverage
3. Sclerotherapy (Not performed at our clinic)
Sclerotherapy involves injecting a chemical agent into the affected area to deliberately induce controlled inflammation, which then leads to healing and closure of the vessel.
Sclerotherapy may be a suitable option not only for lymphangiomas and venous malformations, but also for growths located in deeper layers of the skin.
Compared with surgery, sclerotherapy is less likely to leave visible scarring. On the other hand, it may take more time to notice improvement, and a single session may not fully resolve the condition.
Frequently Asked Questions About Hemangiomas
This section answers frequently asked questions about the need for treatment and the costs involved. We also address questions about angiosarcoma, a malignant vascular tumor, so please take a moment to read through.
Treatment by surgical excision or sclerotherapy is covered by insurance.
V-Beam laser treatment is covered by insurance only when used to treat port-wine stains, strawberry hemangiomas (infantile hemangiomas), or telangiectasia.
If an examination reveals that your condition is something other than a hemangioma, we may recommend treatment options that are not covered by insurance.
We encourage you to visit our clinic for an initial consultation.
Strawberry hemangiomas (infantile hemangiomas) in babies often resolve spontaneously if left untreated.
However, there is a risk that loose skin or scarring may remain, so early treatment is sometimes recommended for cosmetic reasons.
Depending on the location and size of the growth, it may also affect physical function or development. For example, a hemangioma on the airway or neck could potentially interfere with breathing or feeding.
Similarly, a hemangioma near the eyes or ears may ulcerate or bleed as it grows rapidly.
To help prevent secondary complications, we recommend consulting a clinic if you have any concerns.
In some cases, the diagnosis may be angiosarcoma, a malignant tumor (cancer).
Angiosarcoma is a malignant tumor of vascular endothelial cell origin and is a rare condition, accounting for approximately 2% of soft tissue sarcomas. It most commonly affects the head and neck region, particularly the scalp in older adults, and often has a poor prognosis, making early diagnosis and treatment important. A multidisciplinary approach involving surgery, radiation therapy, and chemotherapy is recommended.
The characteristic early signs of angiosarcoma include redness and bruising of the skin. As the condition progresses, the skin may become raised, and blood blister-like nodules may appear.
Although angiosarcoma can develop anywhere in the body, it most commonly occurs on the head and neck. Because pain and itching are often absent, the disease may progress without the patient noticing any symptoms.
If you notice early signs such as skin redness or bruising, we encourage you to consult a clinic promptly.
6 Features of Our Clinic That Patients Appreciate
Team-Based Care Under the supervision of a specialist certified by the Japanese Society of Plastic and Reconstructive Surgery, our clinic brings together physicians from multiple specialties, including plastic surgery, dermatology, and orthopedic surgery.
Attention to Pain Management Our specialists select the most appropriate approach from a wide range of surgical techniques, with the aim of minimizing discomfort throughout treatment.
Gentle on the Skin Laser treatment is delivered while the skin surface is cooled with cooling gas, helping to reduce the burden on your skin.
No Hospital Stay Required — Same-Day Procedures Available From consultation to surgery, the process is streamlined. Same-day outpatient procedures are available.
Conveniently Located Our clinics are situated just a short walk from major transit hubs in central Tokyo.
Insurance Coverage Available Hemangioma treatment at our clinic—including surgical removal and laser treatment for non-cosmetic purposes—may be eligible for insurance coverage, helping to keep costs manageable.
Many of our patients come to us with concerns like these.
Do any of them sound familiar?
- Concerned about a red birthmark or red spot on the face or elsewhere on the body
- Worried after noticing a red birthmark on a newborn baby
- Hoping to have a growth removed with as little scarring as possible
Hemangiomas in adults are unlikely to resolve on their own, and clinical treatment is generally needed to achieve improvement. A consultation is also necessary to make an accurate diagnosis and determine the most suitable treatment approach.
At our clinic, our specialists combine their extensive knowledge across multiple disciplines to provide treatment that aims to minimize discomfort and reduce the risk of scarring.
If you are concerned about a red birthmark or red spot, please feel free to reach out to us for a consultation.
References
- Wassef M, Blei F, Adams D, et al. Vascular anomalies classification: recommendations from the International Society for the Study of Vascular Anomalies. Pediatrics. 2015;136(1):e203-214.
- Enjolras O, Wassef M, Mazoyer E, et al. Infants with Kasabach-Merritt syndrome do not have “true” hemangiomas. Journal of Pediatrics. 1997;130(4):631-640.
- Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plastic and Reconstructive Surgery. 1982;69(3):412-422.
- Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A. Propranolol for severe hemangiomas of infancy. New England Journal of Medicine. 2008;358(24):2649-2651.
- Frieden IJ, Reese V, Cohen D. PHACE syndrome. The association of posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities. Archives of Dermatology. 1996;132(3):307-311.
- Tan ST, Velickovic M, Ruger BM, Davis PF. Cellular and extracellular markers of hemangioma. Plastic and Reconstructive Surgery. 2000;106(3):529-537.
- Zheng JW, Zhou Q, Yang XJ, et al. Treatment guideline for hemangiomas and vascular malformations of the head and neck. Head & Neck. 2010;32(8):1088-1098.
- Garzon MC, Enjolras O, Frieden IJ. Vascular tumors and vascular malformations: evidence for an association. Journal of the American Academy of Dermatology. 2000;42(2 Pt 1):275-279.
- Bauland CG, van Steensel MA, Steijlen PM, Rieu PN, Spauwen PH. The pathogenesis of hemangiomas: a review. Plastic and Reconstructive Surgery. 2006;117(2):29e-35e.
- Boye E, Yu Y, Paranya G, et al. Clonality and altered behavior of endothelial cells from hemangiomas. Journal of Clinical Investigation. 2001;107(6):745-752.
- Drolet BA, Esterly NB, Frieden IJ. Hemangiomas in children. New England Journal of Medicine. 1999;341(3):173-181.
- Chang LC, Haggstrom AN, Drolet BA, et al. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics. 2008;122(2):360-367.
- Achauer BM, Chang CJ, VanderKam VM. Management of hemangioma of infancy: review of 245 patients. Plastic and Reconstructive Surgery. 1997;99(5):1301-1308.
- Tan OT, Sherwood K, Gilchrest BA. Treatment of children with port-wine stains using the flashlamp-pulsed tunable dye laser. New England Journal of Medicine. 1989;320(7):416-421.
- Garden JM, Bakus AD, Paller AS. Treatment of cutaneous hemangiomas by the flashlamp-pumped pulsed dye laser: prospective analysis. Journal of Pediatrics. 1992;120(4 Pt 1):555-560.
