I also had difficulties with this, especially w/FA being so abbreviated. There is one word in FA that helps, and then I have a link for more info: "grows rapidly and regresses spontaneously by 5-8 years old." Which means it's done with its involution phase by then. This NCBI article helps: The Lessons I Learned from a Hemangioma Clinic TLDR: rapid growth occurs for the first few month, followed by a few months of rest, and then years of involution. Since the question is asking what happens over 5 years, the majority of that time is spent in involution phase. Hope this helps.

The strawberry hemangiomas tend to grow and then randomly involute.

I just want to add that I hate this question and I am not sure why the NBME loves to use the worst grammar imaginable.

We all know strawberry hemangiomas spontaneously involute after 5-8 years... why don't they just ask this? Why do they insist on ambiguity of phrases? Why are my board exams trying to trick me with poor english?

Rant over.

In 2019 FA Strawberry hemangioma -- it appears early in life, grows rapidly and regresses spontaneously by 5-8 years old

So in 5 years this hemangioma will spontaneously involute

"..expected over the next 5 years" = it will grow just like it's doing now! It will spontaneously involute but not over the next 5 years - maybe in 5 years.