Congenital Primarily Ulcerated Hemangioma Mimicking Cleft Lip

neonate presented for evaluation of a strange cleft lip. Physical examination showed the presence of a linear ulcer cleaving the upper lip in correspondence of right lateral portion of the philtrum (Figure 1). Moreover, two small ovalar reddish patches visible at Cupid-arch (Figure 2) led us to make diagnosis of congenital ulcerated hemangioma mimicking cleft lip. Propranolol at 2 mg/kg/d was started, resulting in complete ulcer re-epithelization after 20 days and full recovery after 4 months (Figure 3; available at www.jpeds.com). Congenital hemangiomas are rare vascular tumors that are full-grown at birth and do not show accelerated postnatal growth.1 There are 2 main subgroups that probably represent different phases of the same biological phenomenona: rapidly involuting congenital hemangioma and noninvoluting congenital hemangioma.1 Moreover, a different group of hemangiomas with ulceration, usually affecting the perineum or lips and appearing at birth or soon after, are not included in the classication of congenital hemangiomas.2 Ulcerated hemangioma mimicking cleft lip is an exceptional occurrence.3,4 Berenguer et al described a case of a rapidly involuting congenital hemangioma of the upper lip, which produced a morphologic sequel that resembled a microform cleft lip.3 In 1988, Mulliken reported a newborn with a congenital ulceration of the upper lip, who was diagnosed with a cleft lip and developed an obvious hemangioma after 1 month of age.4 Our case could be considered a primitively ulcerated congenital hemangioma responsive to propranolol. This differs from the case reported by Berenguer et al, which presented as a rapidly involuting congenital hemangioma, spontaneously involved without any medical therapy, leaving a residual minimal cleft lip.3 It also differs from

Figure 2. Focus on the borders of ulcer where two small ovalar reddish patches were visible.

the report by Mulliken, in which a primitive ulcerated lesion subsequently evolved to a classic hemangioma.4 n Iria Neri, MD
Dermatology Division Internal Medicine Aging and Nephrologic Disease Department SantOrsola Malpighi Hospital University of Bologna Bologna, Italy

Vincenzo Piccolo, MD Teresa Russo, MD

Department of Dermatology and Venereology Second University of Naples Naples, Italy

Alberto Bianchi, MD
Oral & Maxillofacial Surgery Unit

Annalisa Patrizi, MD, PhD

Figure 1. Ulcer visible just in correspondence of right lateral portion of the philtrum. Dermatology Division Internal Medicine Aging and Nephrologic Disease Department SantOrsola Malpighi Hospital University of Bologna Bologna, Italy

J Pediatr 2013;-:---. 0022-3476/$ - see front matter. Copyright 2013 Mosby Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2012.10.061

References available at www.jpeds.com

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References

www.jpeds.com

Vol. -, No. 3. Berenguer B, Gonzlez Meli B, Mar Molina C, de Toms Palacios E. a n a Rapidly involuting congenital hemangioma (RICH) that simulates a minimal cleft lip. Cir Pediatr 2010;23:130-3. 4. Mulliken JB. Treatment of hemangiomas. In: Mulliken JB, Young AE, eds. Vascular birthmarks: Hemangiomas and malformations. Philadelphia, PA: WB Saunders; 1988. p. 41-62.

1. Mulliken JB, Enjolras O. Congenital hemangiomas and infantile hemangioma: missing links. J Am Acad Dermatol 2004;50:875-82. 2. Liang MG, Frieden IJ. Perineal and lip ulcerations as the presenting manifestation of hemangioma of infancy. Pediatrics 1997;99:256-9.

Figure 3. Complete clinical resolution of ulcer 4 months after the starting of propranolol.
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