Strawberry Naevus
Infantile haemangioma, strawberry haemangioma.
This strawberry naevus shows the typical oval shape, scarlet colouring and site of the lesion.
A large strawberry naevus present on the leg of an infant.
This is the same lesion as above but show several years later. Management was conservative, with the lesion resolving spontaneously. Note however, that although the lesion has resolved, it has left a fibro-fatty residue on the leg which may require plastic surgery to correct.
This strawberry naevus has affected the breast area of an infant girl. The vascular tissue has led to the appearance of premature breast development. This will regress as the lesion resolves.
A strawberry naevus affecting the scalp of an infant. Note the tissue expanding effect of the vascular malformation. This may necessitate surgery to remove any loose skin after the lesion has resolved.
This infant has a strawberry naevus affecting the mid-face, nostril and lower eyelid. Since these lesions tend to achieve their ultimate size within 3-6 months of delivery, it is unlikely to threaten sight or airway and was thus managed conservatively.
The same patient as above is shown here 3 years later.
On occasions haemangiomas can be symptomatic as shown here, with superficial ulceration. This should be treated conservatively, if possible.
The same lesion as above, now well on its way to involution and resolution - no surgical intervention.
Small asymptomatic lesion; should resolve.
Features
Strawberry naevi are NOT present at birth but appear 2-3 weeks afterwards. Clinically, strawberry naevi appear as round or oval lesions with well defined borders and an intense scarlet-red colour. The surface may be smooth or lobulated and their ultimate size (most often between 1 and 25 centimetres) is usually achieved within 3-6 months of delivery. Due to the vascular nature of the lesion, they often appear to increase in size when the child is crying or straining.
60% of strawberry naevi appear on the head and neck with a further 25% appearing on the trunk. Around 20% of lesions are multiple, and there is evidence that a whole body MRI should be considered to rule out internal lesions if there are more than 3 strawberry naevi present.
Incidence
These are the commonest tumours of infancy, with 1-2% of infants having at least one lesion after the first few days of life. Roughly 10% develop a strawberry naevus within one year of life. Females are more commonly affected (3:1). They are more common in premature children.
Aetiology
Benign, developmental vascular tumours of unknown aetiology.
Differential Diagnosis
Vascular malformations
Treatment
Usually, none is required. Nearly all lesions undergo spontaneous involution with 30% resolved by the age of 4, 50% by the age of 5 and 75% by the age of 7. Plastic surgery to remove any loose skin or fibro-fatty deposits around the previous site of the lesions is sometimes required after the lesion has resolved.
If the lesion is causing airway obstruction a tracheostomy will be required. If causing feeding/visual or sight obstruction, intra-lesional steroid therapy may slow proliferation. Some centres now use titrated propranolol to achieve this.
Laser therapy has also been shown to be effective in reducing the size of the lesions.
