Perineal and Lip Ulcerations as the Presenting Manifestation of Hemangioma of Infancy

Hemangiomas are the most common benign tumors of infancy, occurring in 8% to 12% of full-term white infants and up to 22% of preterm neonates weighing less than 1000 g. Hemangiomas are rarely present at birth, but so-called precursor lesions may be evident. These include pale macule(s), which may be mistaken as an achromic nevus or nevus anemicus; erythematous papule(s), a blue patch resembling a bruise; or an erythematous or telangiectatic patch resembling a port-wine stain.1-3 Occasionally, fully formed tumors, often with overlying telangiectasias and peripheral pallor, are present at birth.3 We report four cases of infants in whom the initial presentation was a skin ulceration of either the perineum or lip, with the diagnosis of hemangioma becoming evident days to weeks later. ### Case 1 A 2-week-old white female presented with two punched-out ulcers on an erythematous base in the left gluteal region (Fig1). The mother's history was significant for two episodes of genital herpes. During labor, genital lesions suspicious for herpes prompted a cesarean section 5 hours after spontaneous rupture of membranes. Maternal herpes culture was ultimately negative. On day five a cold sore on the mother's lower lip grew an untypable herpes simplex virus, but rectal and nasopharyngeal cultures of the infant were negative for herpes. Fig. 1. Case 1. Punched out ulcerations at the base of the sacrum. Seven days later, ulcers (without previous vesiculation) were noticed in the sacral area (Fig 1), and the patient was hospitalized for possible neonatal herpes simplex. Her physical examination was otherwise unremarkable. She was treated with intravenous acyclovir, tobramycin …