A 12-day-old girl presents to the dermatology clinic with ptosis, edema, and purple discoloration of the right upper eyelid. She was born at 38 weeks’ gestation via an uncomplicated vaginal delivery. The findings were noted at birth and initially attributed to birth trauma. However, the lesion had slightly grown since birth and was still present at 10 days of age, prompting a presumed diagnosis of infantile hemangioma (IH) of the eyelid by the referring ophthalmologist.

Physical examination shows a well-appearing neonate. Growth parameters include a weight of 3.4 kg (25th-50th percentile) and length of 51 cm (25th-50th percentile). Her temperature is 36.6°C (97.9°F), heart rate is 168 beats/min, respiratory rate is 49 breaths/min, blood pressure is 80/46 mm Hg, and oxygen saturation is 100% in room air. Examination of the eyelid shows a 6.0 × 5.5-cm firm, violaceous growth involving the entire upper right eyelid with complete ptosis (Fig...

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