Birthmarks

About birthmarks
There are two main categories of birthmarks—red birthmarks and pigmented birthmarks. Red birthmarks are a vascular type of birthmark. Pigmented birthmarks are areas in which the color of the birthmark is different from the color of the rest of the skin.

What are red birthmarks?
Red birthmarks are colored, vascular (blood vessel) skin markings that develop before or shortly after birth.

What are the types of red birthmarks?
One common kind of vascular birthmark is the hemangioma. It usually is painless and harmless and its cause is not known. Color from the birthmark comes from the extensive development of blood vessels at the site.

Strawberry hemangiomas (strawberry mark, nevus vascularis, capillary hemangioma, hemangioma simplex) may appear anywhere on the body, but are most common on the face, scalp, back, or chest. They consist of small, closely packed blood vessels. They may be absent at birth, and develop at several weeks. They usually grow rapidly, remain a fixed size, and then subside. In most cases, strawberry hemangiomas disappear by the time a child is 9 years old. Some slight discoloration or puckering of the skin may remain at the site of the hemangioma.

Cavernous hemangiomas (angioma cavernosum, cavernoma) are similar to strawberry hemangiomas but are more deeply situated. They may appear as a red-blue spongy mass of tissue filled with blood. Some of these lesions disappear on their own, usually as a child approaches school age.

Port-wine stains are flat purple-to-red birthmarks made of dilated blood capillaries. These birthmarks occur most often on the face and may vary in size. Port-wine stains often are permanent (unless treated) and may result in emotional distress.

Salmon patches (also called stork bites) appear on 30-50% of newborn babies. These marks are small blood vessels (capillaries) that are visible through the skin. They are most common on the forehead, eyelids, upper lip, between the eyebrows, and the back of the neck. Often, these marks fade as the infant grows.

What are the symptoms of red birthmarks?
Symptoms of red birthmarks include:

• Skin markings that develop before or shortly after birth
• Red skin rashes or lesions
• Skin markings that resemble blood vessels
• Possible bleeding
• Skin that may break open

How are red birthmarks diagnosed?
In most cases, a health professional can diagnose a red birthmark based on the appearance of the skin. Deeper birthmarks can be confirmed with tests such as MRIs, ultrasound, CT scans or biopsies.

What is the treatment for red birthmarks?
Many capillary birthmarks such as salmon patches and strawberry hemangiomas are temporary and require no treatment. For permanent lesions, consealing cosmetics such as Covermark may be helpful. Cortisone (oral or injected) can reduce the size of a hemangioma that is growing rapidly and obstructing vision or vital structures.

Port wine stains on the face can be treated at a young age with a yellow pulsed dye laser for best results. Treatment of the birthmarks may help prevent psychosocial problems that can result in individuals who have a port wine stain.

Permanent red birthmarks may be treated with methods including:

• Cryotherapy (freezing)
• Laser surgery
• Surgical removal

In some cases, birthmarks are not treated until a child reaches school age. However, birthmarks are treated earlier they result in unwanted symptoms or if they compromise vital functions like vision or breathing.

Can red birthmarks be prevented?
Currently, there is no known way to prevent red birthmarks.

What are pigmented birthmarks?
Pigmented birthmarks are skin markings that are present at birth. The marks may range from brown or black to bluish or blue-gray in color.

What are the types of pigmented birthmarks?
Mongolian spots usually are bluish and appear as bruises. They often appear on the buttocks and/or lower back, but they sometimes also appear on the trunk or arms. The spots are seen most often in people who have darker skin.

Pigmented nevi (moles) are growths on the skin that usually are flesh-colored, brown or black. Moles can appear anywhere on the skin, alone or in groups.

Congenital nevi are moles that are present at birth. These birthmarks have a slightly increased risk of becoming skin cancer depending on their size. Larger congenital nevi have a greater risk of developing skin cancer than do smaller congenital nevi. All congenital nevi should be examined by a health care provider and any change in the birthmark should be reported.

Cafe-au-lait spots are light tan or light brown spots that are usually oval in shape. They usually appear at birth but may develop in the first few years of a child’s life.

What causes pigmented birthmarks?
The cause of pigmented birthmarks is not known. However, the amount and location of melanin (a substance that determines skin color) determines the color of pigmented birthmarks. Cafe-au-lait spots may be a normal type of birthmark, but the presence of several cafe-au-lait spots larger than a quarter may occur in neurofibromatosis (a genetic disorder that causes abnormal cell growth of nerve tissues). Moles occur when cells in the skin grow in a cluster instead of being spread throughout the skin. These cells are called melanocytes, and they make the pigment that gives skin its natural color. Moles may darken after exposure to the sun, during the teen years and during pregnancy.

What are the symptoms of pigmented birthmarks?
Symptoms of pigmented birthmarks include skin that is abnormally dark or light, or bluish, brown, black or blue-gray in color. Discolorations of the skin may vary in size and be smooth, flat, raised or wrinkled. Pigmented birthmarks may increase in size, change colors, become itchy, and may occasionally bleed.

How are pigmented birthmarks diagnosed?
In most cases, health care professionals can diagnose birthmarks based on the appearance of the skin. If a mole exhibits potentially cancerous changes, a biopsy may be performed.

How are pigmented birthmarks treated?
In most cases, no treatment is needed for the birthmarks themselves. When birthmarks do require treatment, however, that treatment varies based on the kind of birthmark and its related conditions.

Large or prominent nevi that affect the appearance and self-esteem may be covered with special cosmetics.

Moles may be removed surgically if they affect the appearance or if they have an increased cancer risk.

What are the complications of pigmented birthmarks?
Some complications of pigmented birthmarks can include psychological effects in cases in which the birthmark is prominent. Pigmented birthmarks also can pose an increased skin cancer risk.

A doctor should check any changes that occur in the color size, or texture of a nevus or other skin lesion. See a doctor right away if there is any pain, bleeding, itching, inflammation, or ulceration of a congenital nevus or other skin lesion.

Can pigmented birthmarks be prevented?
There is no known way to prevent birthmarks. People with birthmarks should use a good quality sunscreen when outdoors in order to prevent complications.