Birthmarks

Anatomy or system affected: Skin

Definition: Spots or marks on the skin that are present at birth or shortly thereafter

Causes and Symptoms

Many different types of birthmarks may be present on an infant, such as hemangiomas, stork bites, strawberry marks, port-wine stains, moles, and Mongolian spots. They range in color, size, shape, and longevity.

Hemangiomas (blood-filled birthmarks) occur when an area of the skin receives an abnormal blood supply during fetal or neonatal (newborn) life. As a result, the tissue in this area enlarges over a period of several weeks to months and becomes reddish-blue. A hemangioma is classified according to the type of blood vessels supplying it, which determine its appearance.

The most common birthmark in infants is the stork bite (flat angiomata), a patch of deep pink located on the bridge of the nose, lower forehead, upper eyelids, back of the head, or neck. Most often, stork bites occur in light-skinned babies. They are not considered serious and usually disappear early in an infant’s life.

Strawberry marks or hemangiomas are caused by dilated capillaries (the smallest blood vessels) in the top layers of the skin. A strawberry mark is a raised dot with a rough texture that may be white during the first week of life before it turns red. Thus, this birthmark may not be noticeable at birth but is apparent within the first month of life. It may be located on the face, head, neck, or trunk. Most often, a baby has only one strawberry mark, but occasionally these birthmarks are scattered over different parts of the body. In very rare instances, strawberry marks appear in large numbers on the face and upper trunk and may also be present on organs inside the body. Strawberry hemangiomas typically grow quite rapidly for six months, which is alarming to parents, then gradually shrink and disappear without treatment. Virtually all these birthmarks fade by the time that the child reaches age nine, and most reduce in size at age two to three years.

Port-wine stains (flat hemangiomas) are large, flat, irregularly shaped red, pink, or purple areas caused by a surplus of blood vessels under the skin. They are typically present at birth and enlarge as a child ages. They are found on the face or limbs and are usually located on only one side of the body. Port-wine stains generally remain for life, although they may fade over time or be removed by laser therapy. Port-wine stains, which occur in about one in 300 births, are associated with the rare neurological disorder Sturge-Weber syndrome, which occurs in one in every 20,000 births, especially when the port-wine stain is present on the eyelids or forehead. Both port-wine stains and Sturge-Weber syndrome are thought to be caused by a single, random change to a single gene after conception. Port wine stains are also associated with even rarer disorders, including Klippel-Trenaunay syndrome, Parkes-Weber syndrome, Servelle-Martorell syndrome, Proteus syndrome, Cloves syndrome, and Beckwith-Wiedemann syndrome.

Dark-pigmented birthmarks, termed nevi or moles, are composed of cells that produce melanin. Nevi range in color from yellow-brown to dark brown to black. They are small and relatively common in light-skinned babies, occurring in one of every hundred white newborns. Large nevi, ranging in size from a coin to a spot measuring eight by eleven inches, are rare (occurring in one of every 20,000 births) and more serious, as they may develop into melanoma, a serious skin cancer. These birthmarks can be flat or raised, may have hair growing from them, and can cover the entire limb of a newborn.

Mongolian spots are large, flat spots containing extra pigment that resemble bruises, especially due to their blueish color. They commonly occur in dark-skinned babies and are usually located on the back or buttocks. These birthmarks disappear by the time a child enters school and are of no clinical significance.

Treatment and Therapy

While most birthmarks do not require treatment, certain types must be monitored carefully and treated if they develop further.

Although parents may want to have strawberry marks removed immediately, especially after witnessing their rapid growth in a newborn, it is generally best to leave them untreated. Few complications or cosmetic problems are associated with strawberry hemangiomas that are left alone.

In certain cases, however, intervention is required, such as the presence of the mark near the eye, ear, throat, or mouth. Treatment of these hemangiomas is also initiated if they grow faster than usual, become infected, or bleed profusely. These cases require evaluation and management by a pediatrician and a dermatologist before a plastic surgeon performs the procedure.

In addition, treatment may be undertaken if a child is particularly self-conscious about the mark. Because there is a greater risk of complications and an undesirable change in appearance with intervention, this step must be considered carefully. Cases in which the presence of strawberry marks on internal organs is suspected require tests and monitoring under the supervision of a pediatrician. If therapy is deemed necessary, steroids may be utilized to shrink these birthmarks. The disadvantage of this treatment is the side effects of the steroids. Hemangiomas may also be removed with traditional surgery, which causes scarring.

Port-wine stains rarely cause any problems in an infant or growing child. If they are located in certain areas, however, there is potential for serious sequelae. A flat hemangioma on the upper eyelid or forehead may be associated with Sturge-Weber syndrome, a related problem in the underlying brain structure. Port-wine stains located next to an eye may influence the development of glaucoma, a degenerative disease that leads to blindness if left untreated. In such cases, the birthmark may be removed by laser surgery, which is capable of eliminating the port-wine stain without damaging the skin. Regular monitoring for signs of glaucoma is essential.

Surgery is not recommended for port-wine stains if they simply pose a cosmetic problem; reassurance and a covering makeup are the treatments of choice.

Small nevi tend to grow slightly as the child ages and are usually not associated with any adverse sequelae. Nevertheless, a small percentage of these moles develop into melanoma, a serious skin cancer, usually during or just after adolescence. Thus, nevi should be checked periodically by a pediatrician and observed carefully for any change in appearance (color, size, or shape). In such cases, the mole should be removed by a pediatric dermatologist and sent to a laboratory for biopsy to determine that it is not cancerous.

Perspective and Prospects

Another development in the treatment of birthmarks and skin lesions is laser therapy. Although laser therapy is not widely used on hemangiomas, it has shown remarkable success in the shrinking of strawberry hemangiomas and has been used to remove certain types of port-wine stains. This method causes less scarring than conventional surgical procedures. Most patients need a single five- to ten-minute session under general anesthesia. About a third of patients require one or more subsequent treatments. In some cases, plastic surgery may be needed to tighten loose skin following laser treatment.

Bibliography

" Birthmarks & Hemangiomas." American Academy of Pediatrics, May 11, 2013.

"Common Moles, Dysplastic Nevi, and Risk of Melanoma." National Cancer Institute, November 1, 2011.

Karlsrud, Katherine, and Dodi Schultz. “What to Do About Birthmarks.” Parents 68, no. 9 (September, 1993): 70–72.

“Lifelong Companions: Birthmarks.” Current Health 2 18, no. 8 (April, 1992): 30–31.

"Port-Wine Stain." Medline Plus, May 13, 2011.

“Port Wine Stains.” Vascular Birthmark Institute New York, 28 Nov. 2021, www.vbiny.org/blog/possible-complications-from-port-wine-stains. Accessed 24 July 2023.

"Researchers Pinpoint Cause of Port-Wine Stain Birthmarks." Medline Plus, May 8, 2013.

Shelov, Steven P., et al. Caring for Your Baby and Young Child: Birth to Age Five. 5th ed. New York: Bantam Books, 2009.

Thompson, June. Spots, Birthmarks, and Rashes: The Complete Guide to Caring for Your Child’s Skin. Toronto, Ont.: Firefly Books, 2003.