Common Congenital Disorders-Birth Marks

Hemangiomas:
Hemangiomas often begin as very small marks or dots on the skin. The marks grow rapidly in the first several weeks and may continue to grow for several years. The growth is "out of proportion" to the babies growth (it is growing faster than the baby).


A	B	C
Patient with rapidly growing hemangioma	One month after photo A	2 1/2 years later after laser and medical treatment

The natural course of hemangiomas is usually a disappearance of the lesion ("involution") beginning at around three years of age. This can vary but most hemangiomas have disappeared by age seven. What is often left is a spongy "fibrofatty" mass without the color. This often requires removal. Because most hemangiomas occur away from important parts of the face, and most remain small, hemangiomas can usually be watched. Hemangiomas require early treatment if the lesion is around the eye (potentially blocking the vision), on the nose, lip, or if the hemangioma is getting quite large. Treatment may also be required if the hemangioma tends to have ulcers and bleed. Several options for treatment are available. Traditionally, lesions requiring intervention would be treated by steroids, either with an injection into the hemangioma or giving the steroids by mouth. This is an effective method of treatment in many cases. Other medical treatment is available for very large hemangiomas but these medicines often have side-effects and the patient must be monitored very closely. Recently, lasers have been found to be effective in treating hemangiomas. A skin-surface laser (carbon dioxide laser) can be used if the hemangioma involves the skin, especially if the skin tends to ulcerate and bleed. We have also found that a special laser (KTPor Nd:YAG laser) may be used within the lesion (through a fiberoptic cable) and cause some

decrease in the size of the hemangioma. This maybe a very exciting and effective way to treat hemangiomas early.

Vascular Malformations:
Vascular malformations are a collection of vessels that are present at birth and increase proportionally with the growth of the baby. Often the lesions are deep and difficult to fully define until the baby is older. The vessels can be arteries, veins, lymphatic vessels , or a combination. Often these lesions will get quite big when the baby is crying or when the lesion is placed below the heart (dependent position). If the lesion is mostly lymphatic vessels, the mass may get quite big with respiratory infections (colds). Radiographic studies often demonstrate several main "feeder' vessels into the lesion. It is ineffective to clot these vessels (embolize) without surgically removing the mass. It is often impossible to remove the entire mass without significant damage to surrounding structures. These lesions are often watched unless problems with bleeding or size of the lesion occur.

Pyogenic granuloma:
Pyogenic granulomas are small vascular lesions that may occur spontaneously or after trauma. The lesions tend to bleed with minimal manipulation. Several treatment options are available including freezing (cryotherapy) and surgical removal. If the base of the lesion is not treated, there is a high chance of recurrence. We will often use a surface laser (carbon dioxide laser) to treat the lesion. This will effectively treat the base and leave a minimal scar. Occasionally multiple treatments are required.

There are an array of pigmented lesions (also called nevi) that are seen in the pediatric population. Most of them are insignificant and have a very low probability of turning into skin cancer. Some lesions do have a higher probability of cancer and should be recognized. Other lesion may need to be removed because the location of the lesion makes it difficult to monitor for changes (scalp or back) or because the lesion is aesthetically impairing. The following lesions should be recognized.

Giant congenital nevus:
These lesions are bigger than the routine smaller "moles" and may actually be quite large. Some cover the entire trunk and buttock and are often called a "bathing suit" nevus. Often these lesions have a significant growth of hair. There is an increased risk for melanoma in these lesions but the exact number varies from 2-16%. Fifty percent of melanomas occur within the first two years of age and 80% of melanomas are seen before age seven. Therefore excision of the lesion is recommended at an early age.. As one can imagine, covering the wound after removal of a large lesion may be difficult in a small child. Often used techniques include, skin grafting, repeated partial removal of the lesion, or the use of balloons (expanders) to stretch the adjacent skin.

Nevus sebaceum:
These nevi are often yellow and somewhat oily in appearance. They may be heaped up like wart. Though benign, there is an increased risk for basal cell carcinoma in these lesions during adolescence. Because of this potentialfor cancer, excision is recommended.

Dysplastic nevus:
The name is a descriptive term for a nevus that has an inconsistent appearance. These nevi are precancerous to melanoma and should be removed. They are identified by an irregular border, areas of light and dark pigmentation within the lesion often with a dark center and light brown borders. They often appear during adolescents.