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Prolonged tumour growth after treatment of infantile haemangioma with propranolol

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Infantile haemangioma is the most common tumour of infancy, sometimes requiring treatment because of the risk of functional impairment or permanent scarring. Growth usually ceases by 12 months of age, and the tumour gradually regresses. In 2008, a review of all patients previously seen in seven international treatment centres identified only five children in whom any haemangioma growth was seen beyond 2 years of age, and none beyond 4 years.1

Since 2008, the treatment of choice for haemangiomas has been oral propranolol for several months, for up to 18 months with segmental lesions. When commenced early, propranolol usually leads to rapid cessation of growth and tumour involution that is much more rapid than without treatment.2 We have previously reported our experience with outpatient propranolol treatment of 200 infants.3 We now report a subset of 20 children for whom treatment with propranolol was initially effective and had ended, but was followed by progressive regrowth of the tumour, in some cases over many years. It is recognised that some regrowth is possible after stopping propranolol treatment, but it is usually self-limiting, although it may require a few additional months of treatment. Regrowth rarely occurs after 3 years of age.4 In our series, regrowth occurred in children more than 2 years old; six were…