Birthmarks

A birthmark is a discoloration of the skin that is present at birth or within the first few weeks of life. This discoloration can be due to brown pigment or red blood vessels.

Vascular tumors and malformations are often present at birth and therefore referred to as “ vascular birthmarks”. The most common type of vascular tumor is often referred to as a strawberry hemangioma. The most common types of vascular malformations are commonly called port wine stains and cavernous hemangiomas.

Strawberry hemangiomas usually appear as a single lesion on the head or neck, although they can appear on the trunk and limbs. They are referred to as strawberry hemangiomas because of their shape and color. One in one hundred caucasian females,may have a strawberry hemangioma, which usually appears a couple of weeks after they are born. Boys are less likely to have these lesions. The hemangioma may grow as the child grows for the first year and then it gradually involutes going from a bright red, raised, round lesion to a puckered gray, yellow patch. Once this occurs, most patients do not seek therapy.

A port wine hemangioma is an abnormal collection or network of blood vessels present beneath a layer of otherwise normal skin. The dense network of vessels is the remainder of extra blood tissue that was present during the first month of embryonic life. A port wine hemangioma was so named because the skin appears as though a red, pink or purple liquid such as port wine has been poured over it.

Port wine hemangiomas may be present at birth and grow at the same rate as the normal surrounding skin. In the third, fourth, or fifth decades of life, a port wine hemangioma may become thicker or spongier than the adjacent normal skin and the surface of the hemangioma, which may have been quite smooth during the first decades of life, may develop an irregular and lumpy cobblestone appearance.

A cavernous hemangioma may be characterized by tumor-like networks of dilated blood vessels and/or irregularly shaped, thin-walled spaces that may permeate organ systems. Cavernous hemangiomas appear during childhood and will grow proportionally as the child grows. They can vary greatly in size and are usually under the skin. When they are elevated above the surface of the skin they may appear to be nodular and bluish purple in color. When compressed these lesions will often empty of blood then rapidly refill. There are several sub categories of cavernous hemangiomas.

High flow vascular stains look very similar to port wine stains but they are associated with increased arterial flow. Upon initial presentation, it can be extremely difficult to distinguish the two conditions. Some features that are more commonly present in high flow vascular stains include heterogeneous stain colour, warmth, peripheral pallor, and sharp, archipelago-like borders.

Unlike port wine stains, these high flow stains are often resistant to laser therapy. Ultrasound and MRI may be helpful in diagnosing high flow vascular stains.

Many forms of therapy have been used on hemangiomas in the past, however most have been abandoned because they are either ineffective or because they create another deformity that is as undesirable as the hemangioma itself.

Surgeons have removed port wine hemangiomas and reconstructed the area with skin grafts. Such procedures entail a significant amount of surgery, and the scars that result are often quite objectionable. X-rays, which were used in the past, are now known to be potentially dangerous and are no longer used to treat port wine hemangiomas. A variety of agents have been injected into the involved skin but with no significant success. Liquid nitrogen and the carbon dioxide laser have also been used and proven to be ineffective. Tattooing has been attempted on hemangiomas, but the results are temporary, and merely camouflage the birthmark. The best available treatment options may be the use of lasers which target the vasculature in the skin, such as the Vbeam Perfecta Pulsed Dye and Cutera Xeo long pulsed lasers.

These lasers generate a very powerful light. Laser light produces an enormous amount of energy, which may be finely focused. The laser light passes harmlessly through the top layer of skin. When it hits the red color of the birthmark, the light is absorbed and its energy released as heat. The heat breaks, coagulates or cauterizes the small vessels under the skin. The intense heat produced by the reaction to the laser light may cause a bruise and/or swelling, which gradually disappears. It may require a number of sessions to reach all the layers of a hemangioma. Scar and irregular pigmentation is possible but exceedingly uncommon.