Vascular birthmarks and infantile haemangioma — branching viva

Opening question

Examiner: Take me through this infant. What is the lesion, and how do you frame it? ^[2]

Candidate: This is an infantile haemangioma — a proliferating vascular tumour that was absent at birth, appeared in the first weeks of life, and is now in its rapid proliferative phase. My frame is the two-family fork: vascular tumours proliferate through endothelial growth and then involute, while vascular malformations are structural errors present at birth that grow only with the child. Because this lesion is large and segmental on the face, it carries the highest risk of a syndrome, so my priorities are to classify it, to screen it, and to treat it in the proliferative phase while the window for propranolol is open. ^{[2] [11]}

Examiner: Walk me through the classification. ^[6]

Candidate: The Mulliken and International Society for the Study of Vascular Anomalies framework divides vascular anomalies into two families. Vascular tumours include infantile haemangioma, the congenital haemangiomas (rapidly involuting, non-involuting and partially involuting), kaposiform haemangioendothelioma and tufted angioma, and pyogenic granuloma. Vascular malformations include the capillary port-wine stain, venous, lymphatic and arteriovenous malformations, and the combined syndromes such as Klippel-Trenaunay and Sturge-Weber. The decisive distinction is cellular behaviour: tumours proliferate, malformations do not. ^{[6] [11]}