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This 35-day-old baby has had fullness of the left upper lid since birth. The mass appears to be filled with engorged vessels. The baby is otherwise healthy and had a normal delivery.

1.	The most likely diagnosis is:
	a -- hemangioma The most likely diagnosis in this case is hemangioma.  This is too early and does not have the true characteristics of a metastatic malignancy.  A dermoid is usually at the orbital rim, is firm, and smooth-domed; cellulitis would be “hot” and red.
2.	A significant concern at this time is:
	d -- amblyopia Since the most likely diagnosis is hemangioma, the real concern immediately is amblyopia from possible occlusion of the left eye because of the lid lesion.
3.	You can tell the family:
	e -- (b) and (c) While this condition is likely to regress in the next several months/years, the concern about the possibility of amlyopia from left eye occlusion raises the possibility that treatment would be needed.

This patient was submitted for E-Consultation and this is the reply from the expert mentor:

"Yes, the surface appearance certainly suggests that this is an infantile hemangioma. If so, it is likely to grow more. Although both eyes are closed in these pictures, I am guessing that the left eye does not open sufficiently for the baby to see from that eye when he tries to open both. If so, then treatment is needed. This is too flat and spread out for local steroid injection. I would suggest oral administration of steroids or propranolol. I would favor the latter assuming you have some help available from a pediatrician to monitor the baby's vital signs. Details of a protocol for this is available in the June 2010 issue of the Journal of AAPOS. If the left eye does open sufficiently to see when he is awake, then just observation of the lesion would be reasonable at this point.... "

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