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.