Birthmarks

Birthmarks come in many types, colors, and shapes.   Generally a birthmark is present from birth but there are some types which develop later in childhood such as the common mole.   Many people believe that just because the skin lesion has been present since birth or childhood it will not be harmful to their health.  In some cases, this is not true.  For instance, moles which are flat and irregularly shaped may be melanoma at birth!  Any skin lesion which is unusual should be checked by your dermatologist to ensure that it is benign.

Treatment of a birthmark depends upon the type it is.  Some require surgical excision, others can be treated with laser.  In general, red or purple birthmarks can be treated with laser while most brown, tan or bluish birthmarks require surgical removal.

Hemangiomas: These can either be flat or raised, red or purple bumps located on any area of the skin.  Large lesions can be very disfiguring and require special care from a pediatric dermatologist.

Port Wine Stain: Flat red or purplish and sometimes quite large, these can be present at birth and either darken or lighten with time.  Pulsed dye laser is used to lighten these lesions but many treatments will be required.  Using too high an energy with the laser can lead to permanent scarring.

Cavernous hemangioma: These are deeper in the skin and can be red, blue or purple.  They may appear smaller than they actually are.  Most of the time, they will go away on their own by age 7; however, some hemangiomas bleed or can affect breathing or other vital functions and must be treated with medications or surgery.  Laser treatments can lead to scarring of this type of hemangioma so a pediatric dermatologist should be consulted prior to undertaking any treatment.

Melanocytic Nevi:

Mongolian spots: large flat bluish gray areas appearing on the lower back or buttock region, usually in people of Asian, African or Native American descent. 

Nevus of Ota: blue or gray speckled patch of skin on face, eye or shoulder.  Half are found at birth with the other half appearing in adolescence. Good cosmetic results are obtained with Q-switched laser treatment.

Cafe au lait spot: light tan, flat area with smooth border.  More than one of these or an association with neurofibromas should be checked by a dermatologist to be sure underlying medical problems do not exist.

Bathing trunk nevi: large brown or tan, sometimes hairy lesions.  These nevi carry a risk of developing melanoma and should be followed regularly by a dermatologist.

Nevus spilus: usually small flat oval tan area usually speckled with brown or black areas.  Because of the risk of melanoma occuring in the speckled areas, this lesion should be surgically removed if small, or closely followed by a dermatologist if surgery is not possible due to size.

Other Birthmarks:

Atrophy of skin:  The underlying dermis or subcutaneous tissue has not properly formed, leading to a depressed or scar-like area of skin.  A dermatologist or pediatrician should be consulted to evaluate underlying causes.

Nevus sebaceous: A malformation of the skin, usually found on the scalp or face which can appear light tan with a velvety surface.  Skin cancers may form in this birthmark and it is generally removed with surgery to prevent the occurrence of skin cancer.

Linear epidermal nevus: usually a linear distribution of warty growths, this birthmark can be found on any part of the skin.  Small ones can be surgically removed for cosmetic reasons; however if large and itchy, topical cortisone medications may be prescribed by your dermatologist.  Occasionally, large lesions are associated with other medical problems including seizures or eye problems.