MCQ – 94358

A baby presents with a distinctive skin finding as shown in the image below, making an accurate diagnosis is crucial for determining the appropriate management and prognosis. What is the probable diagnosis?

Correct Answer » D Explanation

The image shows a:

• Bright red vascular plaque.
• Unilateral involvement of the forehead and upper eyelid.
• Well-demarcated lesion.
• Thickened, superficial appearance.
• Segmental distribution over the face.

These features are characteristic of a segmental infantile capillary hemangioma.

D. Infantile capillary hemangioma

• Most common benign vascular tumor of infancy.
• Usually appears during the first few weeks of life, although a faint precursor lesion may be present at birth.
• Undergoes:
  • Rapid proliferative phase (first 6–12 months).
  • Plateau phase.
  • Gradual involution over several years.
• Segmental facial hemangiomas are associated with PHACE syndrome:
  • Posterior fossa malformations.
  • Hemangioma.
  • Arterial anomalies.
  • Cardiac defects/Coarctation of aorta.
  • Eye abnormalities.

Treatment:

• Observation for small uncomplicated lesions.
• Oral propranolol is the treatment of choice for problematic hemangiomas.
• Topical timolol may be used for superficial lesions.

Why the Other Options are Incorrect

A. Port-wine stain (Nevus flammeus)

• Congenital capillary malformation.
• Flat pink to purple lesion.
• Does not proliferate.
• Persists throughout life.
• Associated with Sturge-Weber syndrome, especially in the V1 distribution.
• Unlike the image, it lacks the characteristic proliferative, thickened appearance of an infantile hemangioma.

B. Cavernous hemangioma

• Deep vascular lesion.
• Bluish, compressible swelling.
• Located within subcutaneous tissues.
• Not a superficial bright-red plaque.

C. Naevus simplex (Salmon patch)

• Pale pink vascular lesion.
• Commonly occurs over the glabella, eyelids, or nape of the neck.
• Usually bilateral.
• Spontaneously fades during infancy.