Birthmarks

Birthmarks are areas of discolored and/or raised skin that are usually apparent at birth but sometimes may not be apparent until months or years of life. 

Although the cause of birthmarks is not known, most do not require treatment. Babies with birthmarks should be examined and diagnosed by a doctor.

What are the most common types of vascular birthmarks?

The following are the most common types of vascular birthmarks:

• Nevus simplex (salmon patch). These are characterized by flat, pink patches on the following locations: posterior neck and scalp (Stork bite), between the eyebrows (Angel’s kiss), upper eyelids, nose, or upper lip.  These fade with time. 
• Infantile Hemangioma.  Hemangiomas may be present at birth or within the first weeks of life.  In the first few weeks after they appear, there is a period of rapid thickening that can last up to several months.  However, most lesions stabilize by 3-4 months of age.  Over years, these hemangiomas gradually become lighter and thinner.  At times, there may be residual blood vessels or fatty tissue that is surgically addressed after the patient is at least a few years of age.   Although effective treatments to slow growth of hemangiomas exist, these are only necessary if there is functional compromise (e.g. possibility for obstruction of vision) or if there is concern that there will be significant cosmetic consequences in the future.  For the most part, infantile hemangiomas are only an issue of the skin.   A more in-depth work-up is only necessary in certain instances including:  1) segmental (very large, geographic) hemangiomas of the face 2) segmental (very large, geographic) hemangiomas of the buttock/thigh area 3) and 5 or more hemangiomas of the skin
• Capillary malformation (Port-wine stain). A port-wine stain is a flat, pink, red, or purple mark that is present at birth, often on the face, arms, or legs.  These birthmarks grow proportionately with child.   Capillary malformations on the face may thicken with time.   Laser treatment can improve the appearance of some capillary malformations. For the most part, capillary malformations are only an issue of the skin.  A more in-depth work-up is only necessary in certain instances including large capillary malformations of the face. 

What are the most common types of pigmented birthmarks?

The following are the most common types of pigmented birthmarks:

• Congenital melanocytic nevi (moles). These can be skin-colored, brown or black, flat or raised and small or large. They can occur anywhere on the body. Nevi can also occur in adulthood, but only nevi that are present at birth or during infancy are considered birthmarks.   Most nevi are not at increased risk for skin cancer; however congenital melanocytic nevi that are very large (>20-40 cm in diameter) and associated with satellite lesions (smaller surrounding nevi) may be at increased risk for malignant melanoma and nevi in the central nervous system (neurocutaneous melanosis).
• Cafe-au-lait spots.  This is French for “coffee with milk”. These are usually oval-shaped and light brown.  These birthmarks are not at risk for skin cancer. If your child has six or more café-au-lait spots that are greater than >5 mm if they are pre-pubertal and >1.5 cm if they are post-pubertal, your child may require further evaluation.  Discuss the need with your physician.  
• Mongolian spots. These are blue or blue-gray spots on the lower back or buttocks. They are most common in babies with darker skin, such as African-American or Asian babies. They can be mistaken for bruises and they usually fade with age.