An infant with a vulvar hemangioma that had undergone extensive ulcerative changes was initially diagnosed as having a perineal burn secondary to child abuse. Although genital burns are a well-recognized manifestation of child abuse, knowledge of the natural course of untreated hemangiomas and the uncommon complication of ulceration as well as familiarity with the characteristic patterns of abusive burn injuries may allow the physician to avoid making this misdiagnosis. The confusion in diagnosis led to an extensive social service investigation that, in this case, had a positive outcome for the mother's ability to cope. There exists, however, the possibility of iatrogenic-induced emotional stress if child abuse is misdiagnosed.