Endangering cutaneous infantile hemangioma treated with vincristine: a case report

Infantile hemangiomas are the most common tumors of childhood. They have a well-defined self-limiting natural history. In about 10% of patients, the hemangioma threatens or potentially threatens life or function during the proliferative phase. The most common treatments for such endangering hemangiomas are intralesional and/or oral steroids. Although steroids are well known to slow growth and promote involution in hemangiomas, there may be no effect on proliferation in up to 30% of patients. There are several reports of the use of intravenous vincristine being successfully used for steroid-resistant hemangiomas, although most of these have been described as hemangioendotheliomas. The degree of improvement in such cases is somewhat subjective. We describe a patient with a large steroid-resistant cervicofacial infantile hemangioma causing stridor. The use of intravenous vincristine rapidly improved the clinical state so much that immediate tracheostomy was avoided, and adrenaline nebulizers could be stopped within 1 day of starting vincristine. We believe that this is the first report of objective improvement in the symptom associated with an infantile hemangioma as a result of treatment with vincristine.