From ASLMS: Advances in Infantile Hemangioma Diagnosis and Care

Pictured: Kristen Kelly, MD, gives a talk at ASLMS 2025 in Orlando.

New guidelines from the International Society for the Study of Vascular Anomalies (ISSVA) offer more precise classification and improved multidisciplinary pathways for patient care.

Kristen Kelly, MD, Professor of Dermatology and Surgery and chair of the Department of Dermatology at the University of California, Irvine, presented major updates in vascular anomaly classification and clinical management during her recent session at the American Society for Laser Medicine and Surgery (ASLMS) Annual Meeting in Orlando. Building on the ISSVA 2025 update, Dr. Kelly emphasized the importance for dermatologists to accurately distinguish between vascular tumors and malformations to guide appropriate diagnostic workup, referrals, and treatment strategies.​

Refinements and the Need for Early Workup

The 2025 ISSVA update classified vascular tumors into benign, borderline, and malignant groups while expanding categories for vascular malformations. Dr. Kelly urged clinicians to review the updated classification system, reminding attendees that “accurate subclassification is essential for prognosis and treatment planning.”​

She also provided clinical examples, including infantile hemangiomas and port-wine stains. In cases of large, segmental infantile hemangiomas, Dr. Kelly said physicians should consider syndromic associations such as PHACE syndrome, necessitating cardiac imaging and ophthalmologic evaluation. Port-wine birthmarks affecting the forehead or periocular region may indicate Sturge-Weber syndrome, warranting neurologic and ophthalmologic assessment.​

Dr. Kelly also cautioned that neuroimaging performed before 1 year of age may yield false-negative results, although this is currently being evaluated and may depend on the imaging protocol, underscoring the need for serial evaluation when clinical suspicion remains high.​

Combining Laser Therapy and Systemic Management

Dr. Kelly reiterated that laser therapy remains a cornerstone in managing vascular lesions. She noted that selection of wavelength and pulse duration selection should be based on vessel size and depth, and that pulsed dye lasers (595 nm) are preferred for superficial vessels, while Alexandrite lasers (755 nm) are more effective for deeper lesions. Systemic beta-blockers such as oral propranolol continue to be the first-line therapy for infantile hemangiomas, with topical timolol reserved for smaller, superficial lesions. Dr. Kelly also discussed the investigational role of photodynamic therapy in complex vascular malformations.​

Dr. Kelly ended her talk with the importance of coordinated management for optimal outcomes in complex or syndromic cases.​

“Vascular anomalies are best approached early and systematically, using both updated classification frameworks and multidisciplinary teams to optimize outcomes.”

Source: Kelly K. Presented at: American Society for Laser Medicine and Surgery (ASLMS) Annual Meeting; April 24-26, 2025; Orlando, FL.