Hemangioma Severity Scale (HSS): Face or Ear

The Hemangioma Severity Scale (HSS) can be used to determine the severity of a hemangioma involving the face or ear.

Patient selection: hemangioma of the face or ear

Parameters:

(1) location

(2) risk for associated structural anomalies

(3) complications

(4) pain

(5) size in centimeters (longest dimension)

(6) disfigurement risk

Parameter	Finding	Points
location	peripheral face	3
	central face excluding nasal tip, lip or periocular	5
	nasal tip, vermillion or cutaneous lip, periocular	6
	ear	6
structural anomalies	none	0
	facial AND >= 5 cm long	6
infection, bacterial	no	0
	yes	1
ulceration	no	0
	yes	2
feeding difficulties	no	0
	yes	2
torticollis	no	0
	yes	2
cartilage distortion or destruction	no	0
	yes	3
airway involvement	no	0
	yes	3
visual compromise	no	0
	yes	3
hypothyroidism	no	0
	yes	2
anemia	no	0
	yes	2
congestive heart failure	no	0
	yes	2
GI bleed	no	0
	yes	2
hepatic dysfunction	no	0
	yes	2
pain	none	0
	mild, intermittent OR does not require systemic medication	1
	moderate, requires OTC pain med	2
	severe or requires systemic prescription pain medication	3
	severe, requires hospitalization for pain control	4
size in longest dimension	<= 1 cm	1
	1.01 to 5 cm	2
	5.01 to 10 cm	3
	10.1 to 20 cm	4
	> 20 cm	5
risk for disfigurement	none	0
	minimal skin textual changes or telangiectasia	2
	redundant fibrofatty tissue	3
	scar without distortion of anatomic landmarks	3
	permanent deformity of normal anatomic landmarks	4

where:

• Some of the complications like torticollis or GI bleeding may not be relevant for a facial hemangioma.

total score =

= SUM(points for all of the parameters)

Interpretation:

• minimum score: 0

• maximum score: 51

• The higher the score the more severe the hemangioma.

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