The traditional nomenclature of vascular lesions has been enlarged and modified with the usage of newer diagnostic techniques. Digital technology has enhanced the precision of older analog tools such as Doppler flow studies. Angiograms have also more precisely delineated flow patterns to allow planned surgical intervention as an important therapeutic option. With the newer classification, it now is possible to plan and anticipate the course of lesions and medically intervene in tumors that potentially will enlarge and impinge on essential structures. Now, the routine workup will clarify if there is internal involvement (eg, liver, etc) and detect proliferative potential mandating medical or surgical intervention. Watchful waiting, the traditional approach is now changing with the newer delineation of syndromes such as PHACE (posterior fossa, hemangioma, arterial lesions, cardiac abnormalities/aortic coarctation, eye abnormalities), which mandate the fullest evaluation and, in many instances, the collaboration of multispecialty groups to treat those lesions as the data and group consensus determines.