Vascular cell tumors of the hand in children.

The diagnosis of vascular cell tumors of the upper limb in children can be extremely difficult. There is considerable variation in their presentation and natural history. In most instances, the correct diagnosis can be achieved after a careful history and examination. Almost invariably, they are benign lesions and, of these, hemangiomas and vascular malformations account for more than 90%. Worrying tumors of the intermediate and malignant grade are rare. Any atypical, rapidly growing tumor with superficial ulceration and bony destruction on radiology should be regarded as malignant. Histologic differentiation of all problematic vascular swellings requires the services of an experienced pediatric vascular pathologist. In the future, specific cellular marker profiles of individual lesions may simplify the diagnosis. Conservative, symptomatic management is the first line of treatment for almost every vascular swelling. Intervention is reserved for swellings complicated by ulceration, uncontrollable rapid growth, coagulopathies, cardiovascular compromise, or the possibility of malignancy. Small lesions may generally be simply excised, whereas larger lesions often remain a problem.