Surgery is not the first-line treatment option for patients with hemangioma. It is usually reserved for patients with either massive protuberant proliferating hemangioma and lesions that are refractory to less invasive treatments.

• Surgical management involves excision, laser treatment or both. ^[1][2]
• Intralesional steroid treatment is also an option for focal hemangiomas such as:
  • Parotid
  • Nasal tip
  • Subglottis
  • Eyelid
• Repeat therapy is often required, but systemic side effects are limited.
• Excision is the appropriate for localized lesions the fibrofatty remnants (residuum) of involuted hemangiomas.
• Elective subtotal excision of massive protuberant proliferating hemangiomas can be employed in order to maintain aesthetic facial boundaries.
• Small remnants of disease are then left for involution.

• Excision is the appropriate for localized lesions the fibrofatty remnants (residuum) of involuted hemangiomas.
• Elective subtotal excision of massive protuberant proliferating hemangiomas can be employed in order to maintain aesthetic facial boundaries.
• Small remnants of disease are then left for involution.

Pulsed dye laser is considered to be effective choice for a series of skin disorders including superficial hemangiomas.^[3]

• Residual erythema and telangiectasias frequently remain in involuted hemangiomas and are best treated by selective photothermolysis using the flash pulse dye laser (FPDL).
• Ulcerative lesions during proliferation can be treated with FPDL to induce healing and new epidermal growth.

• IPL flash lamps emit broadband polychromatic high-intensity light in the wavelength spectrum ranging 515-1200nm.^[3]
• They target vessels at various depths inside the skin.
• The effect relies on selective photothermolysis.
• The indication spectrum includes vascular tumors including hemangiomas.