My 12-year-old son has lumpy red areas on his tongue that bleed. They were removed and biopsied and were called "benign hemangiomas." They've been removed twice and grown back each time. They make his tongue swollen on one side and painful. Is there any way to get rid of them completely? What causes them? Do I have to worry about cancer? He's also been seen by a skin specialist and an ENT, who did the biopsies and admits he really doesn't know much about this.

T.M.

As you have discovered, such lesions are notoriously difficult to eradicate. But let me back up a bit, because your doctors may have been a little imprecise in their use of medical terminology.

Properly speaking, your son has a "vascular malformation," and not a hemangioma. Here's the difference. Hemangiomas are usually noticed in the first year of life. They grow gradually during the first year, but they then regress (shrink) over the next five to 10 years. Vascular malformations, on the other hand, are present at birth but continue to grow larger as the child gets older. They may remain quite small, only to grow in response to trauma or hormonal fluxes (as with puberty). Unfortunately, incomplete surgical excision can lead to further growth, too.

Some vascular malformations are not present at birth but develop following severe trauma. As the injury heals, an inappropriate connection develops between arteries and veins. The resulting lesion is known as an "arteriovenous malformation."

If your son's ENT admits that he doesn't know much about this problem, then he has an obligation (in my opinion) to either learn about the problem or refer your son to an ENT who DOES know about the problem.

Is there any way to get rid of this problem? A variety of treatments are possible. These include sclerotherapy (injection of a chemical that will cause scarring within the abnormal vessels), cryotherapy (use of cold temperatures to induce scarring), surgical excision, embolization (injection of a substance into the vessels in order to block them from within) and laser therapy. Laser therapy is arguably the most promising of these options. Unfortunately, in medicine, if there are a dozen treatments for a single problem, it often means that none of them are terribly effective.

What causes vascular malformations? If your son never seriously injured his tongue, then he was probably born with the problem. Although there are some rare genetic (inherited) conditions that predispose a person to developing vascular malformations, most of the time this is just a case of simple bad luck.

Do you have to worry about cancer? We are taught in medical school, "Never say 'never,'" which means, "Sure, anything is possible." So, I am going to hedge on this question, and say that cancer is very unlikely, but not impossible.