Explaining infantile haemangioma, propranolol and safety-netting — OSCE

Communication and structured-discussion OSCE on explaining a diagnosis of a problematic infantile haemangioma to a parent, covering the tumour-versus-malformation distinction and the proliferate-then-involutive natural history, the decision to start oral propranolol and its hypoglycaemia and feeding safety-netting, why a large facial lesion needs a PHACE syndrome workup, and how the long-term outcome and any residue will be managed.

osce communication diagnosis treatment safety-netting4 min readVerification in progress

Prompt

A 2-month-old infant is referred with a rapidly growing, bright-red raised haemangioma on the upper eyelid that is threatening vision and has appeared over the last six weeks. The parents are anxious that it will not go away and have read about propranolol. The candidate must explain the diagnosis and natural history, the rationale for oral propranolol and its safety-netting, why the periocular site matters, and what the long-term plan is.

Candidate instructions (8-minute station)

You are the paediatric registrar in the clinic. A 2-month-old infant has a rapidly growing, bright-red raised haemangioma on the upper eyelid that appeared at three weeks of age and has enlarged over six weeks. The parents have read about propranolol on the internet and are anxious. ^[2]

Your tasks are: ^[2]

Explain what the lesion is and what the natural history will be, in plain language. ^[2]
Explain why this particular lesion needs treatment and why you will use oral propranolol. ^[1]
Explain the propranolol safety-netting — the hypoglycaemia risk and what to watch for. ^[7]
Explain the long-term plan and what may remain after the lesion has involuted. ^[11]

You are not expected to perform the PHACE imaging yourself in the station, but you should explain that further checks are part of the plan because the lesion is large on the face. ^[7]

References4Show

[1]Léauté-Labrèze C; Dumas de la Roque E; Hubiche T; Boralevi F; et al Propranolol for severe hemangiomas of infancy. N Engl J Med, 2008.PMID 18550886
[2]Krowchuk DP; Frieden IJ; Mancini AJ; Darrow DH; et al Clinical Practice Guideline for the Management of Infantile Hemangiomas. Pediatrics, 2019.PMID 30584062
[7]Drolet BA; Frommelt PC; Chamlin SL; Haggstrom A; et al Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics, 2013.PMID 23266923
[11]Sebaratnam DF; Rodríguez Bandera AL; Wong LF; Wargon O Infantile hemangioma. Part 2: Management. J Am Acad Dermatol, 2021.PMID 34419523

Explaining infantile haemangioma, propranolol and safety-netting — OSCE

osce communication diagnosis treatment safety-netting4 min readVerification in progress

Candidate instructions (8-minute station)

Your tasks are: ^[2]

Explain what the lesion is and what the natural history will be, in plain language. ^[2]

Explain why this particular lesion needs treatment and why you will use oral propranolol. ^[1]

Explain the propranolol safety-netting — the hypoglycaemia risk and what to watch for. ^[7]

Explain the long-term plan and what may remain after the lesion has involuted. ^[11]

You are not expected to perform the PHACE imaging yourself in the station, but you should explain that further checks are part of the plan because the lesion is large on the face. ^[7]

References4Show

[1]Léauté-Labrèze C; Dumas de la Roque E; Hubiche T; Boralevi F; et al Propranolol for severe hemangiomas of infancy. N Engl J Med, 2008.PMID 18550886
[2]Krowchuk DP; Frieden IJ; Mancini AJ; Darrow DH; et al Clinical Practice Guideline for the Management of Infantile Hemangiomas. Pediatrics, 2019.PMID 30584062
[7]Drolet BA; Frommelt PC; Chamlin SL; Haggstrom A; et al Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics, 2013.PMID 23266923
[11]Sebaratnam DF; Rodríguez Bandera AL; Wong LF; Wargon O Infantile hemangioma. Part 2: Management. J Am Acad Dermatol, 2021.PMID 34419523