Historical Perspective
The role of physicians in the care of children with vascular birthmarks
and malformations can be traced back for centuries.1The first formalized collaboration of physicians caring for patients
with vascular anomalies was in 1976, organized by Anthony Young from
London and John Mulliken from Boston. This group convened a scientific
society for the study of vascular malformations and hemangiomas, and
founded the International Society of the Study of Vascular Anomalies
(ISSVA) in 1992. ISSVA continues to meet every 2 years, bringing
together experts from different specialties across the world dedicated
to the care of patients with vascular anomalies. The first vascular
malformation and hemangioma clinics developed within the practices of
surgeons, dermatologists, and other proceduralists who were the primary
recipients of referrals for these patients. The first robust,
multidisciplinary vascular anomalies program was developed at Boston
Children’s Hospital based on the work of Drs. John Mulliken, Anthony
Young, Julie Glowacki, and Judah Folkman. With the development of the
first classification system for vascular anomalies in
1982,2 the complexity and unique management
requirements of these tumors became clearer. Centers began to move
towards an interdisciplinary approach, reflected both in the development
of new clinical programs, as well as the inclusion of more specialists
within ISSVA and other professional groups.
One of the first major vascular anomalies program to develop within a
hematology-oncology division was the Hemangioma and Vascular
Malformations Center established at Cincinnati Children’s Hospital in
2001. The organization of this program has been instrumental in guiding
development of similar programs around the nation, primarily through
establishing clear roles for clinical, leadership, support and research
teams. The establishment of this program brought the role of the
pediatric hematologist-oncologist in the care of vascular anomalies to
the national stage. Hematologists-oncologists are well poised to take on
this central role within vascular anomalies programs, bringing to the
team their knowledge of chemotherapeutic agents, experience managing
coagulopathy, expertise in caring for patients with complex medical and
surgical needs, and robust clinical research capabilities.