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Summer 2011

Birthmark and Vascular Anomalies Center

The UCSF Birthmark and Vascular Anomalies Center was founded in 1991 to provide care to patients with vascular growths such as hemangiomas, other vascular tumors and vascular malformations including venous, lymphatic, arteriovenous and mixed malformations. It is the only center of its kind in Northern California.

Professor William Hoffman, M.D., chief of plastic and reconstructive surgery at UCSF Benioff Children's Hospital, said, "People tend to refer to all of these anomalies as hemangiomas, but it's very important to distinguish between real hemangiomas and vascular malformations."

William Hoffman

Hemangiomas traditionally get bigger in infancy, and then gradually regress, or involute, he said. "True vascular malformations tend to progress over time, and there are a variety of associated syndromes."

Hoffman directs the center with Professor Ilona Frieden, M.D., director of pediatric dermatology, and Professor Christopher Dowd, M.D., an interventional radiologist. In a study they published with colleagues, only 22 percent of patients had correct, specific diagnoses before coming to UCSF.

Ilona Frieden

Diagnosis and Treatment

To help determine a correct diagnosis, a multidisciplinary team of specialists — including the three co-directors, a dermatologic surgeon and an otolaryngologist — conducts a physical exam and reviews MRI scans and pathology reports. The center then tailors a plan for each patient from a full range of treatment options.

For hemangiomas, medical therapy using propranolol has in some cases improved patients' conditions within days, though long-term outcomes are still under review. Dermatologists can administer laser treatment for some lesions. Some vascular malformations and hemangiomas can be removed surgically; plastic surgeons provide tissue grafts or reconstruction as necessary.

Photo: Lobular capillary hemangioma, before and after surgery.

In other cases, radiologists can sclerose lymphatic or venous malformations, injecting an irritant which causes the vessels to thrombose and collapse. While it may not be possible to remove exceptionally large malformations, the center can provide interventions to control bleeding and growth.

The team often recommends surgical removal of pigmented birthmarks to decrease risk of melanoma and reduce disfigurement. Surgeons implant a silicone balloon, called a tissue expander, under normally pigmented skin adjacent to the birthmark.

Christopher Dowd

The tissue expander is injected weekly with saline for about three months, gradually increasing the normal skin above it until there is enough to replace the lesion

"Although there are scars involved with these procedures, we try to hide these in the natural junction lines, such as the side of the nose and along the brows and hairline," Hoffman said. "We really apply techniques used in cosmetic surgery."

Consultations and Referrals

For more information, please contact the Birthmark and Vascular Anomalies Center at (415) 353-7823 or bvac@derm.ucsf.edu.

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