Birthmarks

Birthmarks are a common finding in children. Typically, birthmarks are different types of noncancerous vascular tissue. Although most of these are apparent at birth, they may become noticeable at different ages.

Hemangiomas are collections of vascular cells that are usually raised above the skin. These lesions are typically red, soft, and usually compressible. They range in size from a millimeter to a few centimeters, and less commonly are they larger than five centimeters. They may occur in up to 3 percent of newborns. About 65 percent are superficial, and primarily capillary in nature. The cavernous or deep type represent an additional 15 percent, and the remaining 20 percent of hemangiomas present as a mixed picture with components of [Page 255]both superficial and deep growths. Sometimes, deeper lesions appear darker red or bluish in color.

There are more hemangiomas in female infants and premature infants, and statistically most hemangiomas found in the first month of life occur on the head and neck, followed by the trunk, and then the extremities. Hemangiomas typically have a period of rapid growth for several months and may grow until the child is approximately one year old. At that time, most hemangiomas have reached their maximum size and their growth rate plateaus. The collection of cells then usually involute over time, occasionally ulcerate, and then shrink and disappear. Seventy-five percent of hemangiomas have resolved by five to six years of age.

Although therapies exist to manage hemangiomas, including topical or injected steroids, surgery, laser therapy, chemotherapeutics, radiation, cryotherapy, antifibrinolytics, among others, most regress and completely disappear without treatment within five years. Bleeding and infection may complicate the process; therefore, treatment options must be weighed based on potential scarring or loss of function prior to initiation of therapy, or potential side effects subsequent to treatment.

The second major type of birthmark is vascular malformation. These abnormal groupings of blood vessels are usually flat on the skin and do not typically enlarge. The capillary growths range in color from pink to red to purple, and they may involve both superficial and deeper vessels and tissue. Although these birthmarks may fade, they often persist into adulthood. One superficial grouping of dilated capillaries is called a “stork bite” or “salmon patch.” These light red areas commonly found on the nape of the neck occur in 40 percent of all infants. Sometimes during physical exertion or crying, these areas may become more noticeable and erythematous, or a deeper red color.

Another type of vascular grouping is known as a “port-wine stain.” This particular vascular abnormality often involves deeper tissue, therefore there also may be associated local bone irregularity and neurologic symptoms related to the abnormality. Sometimes children with this type of birthmark and specific involvement of the ophthalmic branch of the fifth cranial nerve (trigeminal) may also have vascular abnormalities involving brain tissue or the blood vessels feeding the brain. Children with these syndromes may also have associated seizures, mental retardation, hemiplegia, and glaucoma. “Portwine stains” tend to darken over time. Categorically, since vascular malformations are congenital abnormalities, they are more permanent and may persist throughout life. Treatment for these conditions is based upon functional impairment or cosmetic desire, and may involve surgical intervention or flashlamp pumped pulsed dye laser (FPDL).

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