Hemangioma Severity Scale (HSS): Nonfacial

The Hemangioma Severity Scale (HSS) can be used to determine the severity of a hemangioma involving a nonfacial area.

Patient selection: hemangioma other than on face or ear including scalp and neck

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	mucous membranes (excluding lip)	1
	extremity or trunk (non-perineal)	1
	breast	2
	perineal, perianal or genital	3
	lumbosacral	2
	scalp or neck	2
structural anomalies	none	0
	midline lumbosacral spine and >= 2.5 cm long	5
	perineal, perianal, genital AND segmental	5
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	<= 5 cm	1
	5.01 to 15 cm	2
	> 15 cm	3
risk for disfigurement	none	0
	minimal skin textual changes or telangiectasia	0
	redundant fibrofatty tissue	1
	scar without distortion of anatomic landmarks	1
	permanent deformity of normal anatomic landmarks	2

where:

• Some of the complications like visual compromise may not be relevant for a nonfacial hemangioma.

total score =

= SUM(points for all of the parameters)

Interpretation:

• minimum score: 0

• maximum score: 43

• The higher the score the more severe the hemangioma.

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