next step with Hemangioma

My daughter has a large hemangioma birthmark right in the middle of her chest--it's about a 3 inch wide circle. She is now 10 and there is no longer any change or improvement. While her skin is now a pale pink and not the bright red, the skin is very wrinkled.
She has indicated that she is now ready to have it "removed" and obviously is at the age when she will soon have breasts as well. My insurance company says they will pay for "correction" but have not been able to guide me as to the next step. Is is worth it to try dermatologist laser treatments or simply go to a surgeon for removal and then a dermatologist for any remaining scarring issues?  It's seems to be me she is beyond any help from the dermatologist--at least in terms of an acceptable appearance.

[BhumikaMD]

Hi,

Hemangiomas are connected to the circulatory system and filled with blood. The appearance depends on location. If they are on the surface of the skin they look like a ripe strawberry, if they are just under the skin they present as a bluish swelling. Sometimes they grow in internal organs such as the liver or larynx. In most cases, hemangiomas will disappear over time. They are formed either during gestation or most commonly they are not present at birth but appear during the first few weeks of life. They are often misdiagnosed, initially, as a scratch or bruise but the diagnosis becomes obvious with further growth.

Most hemangiomas disappear without treatment, leaving minimal or no visible marks. Large hemangiomas can leave visible skin changes secondary to severe stretching of the skin or damage to surface texture.The mainstay of treatment is oral corticosteroid therapy. Other drugs such as interferon or vincristine are sometimes considered if the corticosteroids do not work. If this fails, surgical removal often becomes necessary. Blockage of the airway will often require a tracheostomy to be performed (insertion of an external airway through the front of the neck into the trachea below the level of the obstruction). Smaller raised lesions are sometimes treated with injection of corticosteroid directly into the lesion. Pulsed dye laser can be useful for very early flat superficial lesions if they appear in cosmetically significant areas or for those lesions that leave residual surface blood vessels in the case of incomplete resolution. Unfortunately raised lesions or lesions under the skin do not respond to laser.

You should visit a dermatologist and then plan out the therapy from there. If required the dermatologist will refer you to the surgeon.

You may find more informations at: http://en.wikipedia.org/wiki/Hemangioma

Hope this helped. Please let me know if you may need any more information

[sweetpea03]

I'd contact a pediatric plastic surgeon. Try and find one who has experience with hemangiomas. Depending on your location, I can give you a a few names if you'd like. let me know if you need any more info.