From The New England Journal of Medicine, November 11, 1999
The editors have written most of the 11 chapters and, as the title suggests, have limited their scope to lesions of the head and neck. The editors have extensive clinical experience in the field and direct a multispecialty center for the treatment of vascular anomalies. The book has several color figures of excellent quality, and the bibliography, though not extensive, is current.
The first chapter tackles the task of classifying congenital vascular lesions. The classification system used in this book is largely based on Mulliken and Glowacki's original biologic classification, with an emphasis on our evolving understanding of vascular and arteriovenous malformations. Chapter 2 thoroughly discusses the natural history of hemangiomas, including their appearance in infancy and the changes that typify the proliferative and involutional phases. The authors of this chapter also describe various outcomes associated with hemangiomas of the head and neck. They propose that 60 percent of patients with these lesions will require surgical intervention and that a minority of head and neck hemangiomas regress completely. This is probably an overestimate of the percentage of head and neck hemangiomas that will require medical and surgical treatment: most patients with small hemangiomas in this region are never referred for care by specialists, and most such hemangiomas resolve spontaneously. Even very large cutaneous hemangiomas of the scalp, mandibular region, and neck often involute, with excellent cosmetic results. The authors' approach to the management of hemangiomas may reflect their experience at a major center for the treatment of vascular lesions, where there is an emphasis on surgical correction.
An extensive description of the pathologic features of vascular malformations and hemangiomas is given in chapter 5. Until very recently, this discipline failed to recognize the many changes in the terminology used to describe vascular lesions. This chapter provides an excellent summary that will be helpful in the diagnosis and subsequent management of vascular lesions. Likewise, chapter 6 provides a comprehensive description of recent advances in diagnostic imaging.
The remainder of the book is devoted to the treatment of vascular lesions. There is a detailed overview of options for the treatment of hemangiomas, including pharmacologic therapy, laser surgery, and surgical excision. The description of each pharmacologic agent is clear and includes indications, timing of therapy, dosage schedules, and potential side effects. The initial dose of oral prednisone recommended for the treatment of proliferating hemangiomas is high, at 5 mg per kilogram per day (most practitioners use 2 to 4 mg per kilogram per day), once again possibly reflecting the severely affected population of patients the authors treat. There is a complete discussion of the surgical excision of hemangiomas, an option that probably is underrecognized, particularly among nonsurgical specialists. Surgical excision of hemangiomas, when performed by experienced hands and in the appropriate situation, can be a viable solution, particularly for hemangiomas of the periocular region. Laser surgery, sclerotherapy, surgical resection, and embolization of venous, lymphatic, and arteriovenous malformations are discussed briefly.
Although the book is relatively short and limited in scope, it reads well and is recommended for clinicians, particularly those who care for patients with vascular lesions (pediatricians, otolaryngologists, dermatologists, and plastic and vascular surgeons).
Reviewed by Beth Drolet, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
