title: Infantile hemangioma:  clinical assessment of the involuting phase and implications for management.
abstract: BACKGROUND
  Infantile hemangioma involutes during childhood; the tumor decreases in size and its color fades. Reconstructive procedures are often withheld until the lesion stops improving. The purpose of this study was to determine the age at which involution of infantile hemangioma ends, and factors that influence its regression.
  
  
  METHODS
  Consecutive patients with infantile hemangioma managed between 2007 and 2011 were studied retrospectively. The outcome variable was age at which the appearance of the infantile hemangioma ceased to improve. Predictive variables were sex, lesion size, location, tumor depth, ulceration, and history of treatment (local or systemic corticosteroid).
  
  
  RESULTS
  The study comprised 81 patients. Infantile hemangioma was located on the head/neck (79.0 percent), trunk (13.6 percent), or extremity (7.4 percent). Average tumor area was 9.3 ± 9.7 cm. Twenty-six percent of the cohort was treated with a corticosteroid during the proliferative phase and 87.6 percent underwent reconstruction for a residual deformity. Kaplan-Meier analysis estimated that involution ceased at a median age of 36 months (interquartile range, 30 to 42 months), and 92 percent of tumors completed involution by 48 months. Multivariate Cox proportional hazards regression model showed that sex (p = 0.80), lesion size (p = 0.09), location (p = 0.77), tumor depth (p = 0.74), ulceration (p = 0.18), and previous local (p = 0.73) or systemic (p = 0.60) corticosteroid treatment did not influence regression.
  
  
  CONCLUSIONS
  Most infantile hemangiomas do not improve significantly after 3.5 years of age. Reconstructive procedures should be considered at this age; the tumor has been allowed to regress and the deformity is improved before the development of long-term memory and psychosocial morbidity.
authors.affiliation: Boston, Mass. From the Departments of Plastic and Oral Surgery and Anesthesia, Children's Hospital Boston, Harvard Medical School.
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Couto
authors.forename: Reid A
authors.initials: RA
authors.lastname: Maclellan
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Arin K
authors.initials: AK
authors.lastname: Greene
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006391:Hemangioma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D053685:Laser Therapy; D008297:Male; D015999:Multivariate Analysis; D009365:Neoplasm Regression, Spontaneous; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*
chemical_list: D000305:Adrenal Cortex Hormones