Birth Marks

Coloured marks on the skin that are present from birth or develop shortly after birth.

Can generally be classified as either pigmented, vascular or other.

Pigmented Birthmarks

Congenital Melanocytic Naevus

Congenital_melanocytic_nevus_01

  • Common (1-3%), caused by over-proliferated melanocytes.
  • Usually appear initially as flat, pigmented lesions at birth and may may raise and grow hair as it ages, although many remain flat patches which grow with the child.  Can be small (<1.5cm), medium (<20cm), large (<40cm) or giant (>40cm)
    • There is a small risk of melanomatous development, particularly with larger and/or nodular/irregular lesions
      • The decision to excise the lesion may be taken in small lesions but may not be possible in large/giant lesions
        • Giant lesions may require recurrent shaving of the superficial layers and/or curettage
        • Excision may be done for cosmetic reasons, concern over cancer, changes, a difficult area to monitor e.g scalp, sole etc
    • Otherwise, reassurance is all that is required.

Cafe au lait Spot

  • Common (solitary macules can be found in up to 15% of the population).
  • Usually oval, light brown (milky-coffee) colour patches (>0.5cm)

DCF 1.0

  • If one is noticed, others should be looked for.  >6 cafe au lait marks (as well as other signs e.g. axillary freckling and macules) requires referral for the possible diagnosis of neurofibromatosis type 1.

Mongolian Spot (Dermal melanocytosis)

img0003

  • Blue-gray patch of skin usually affecting the lumbar region/buttocks, usually a few centimetres but can be larger
  • Thought to be due to failure of migration of melanocytes and entrapment within the dermis.
  • Far more common in Asian/Eastern population (up to 90%)
  • Most will disappear by age 3-5, but dark/large lesions may persist indefinitely
  • DO NOT CONFUSE WITH BRUISING (and vice versa)

Vascular Birthmarks

Stork Bite/Salmon Patch/Angel Kisses (Naevus Simplex)

stork2

  • Common (33% of newborns)- flat, ‘salmon-coloured’ lesions usually over the eyes, scalp and neck, and can be bilateral and symmetrical- caused by telangiectasias within the dermis.
    • Blanch when pressed
  • 40% resolve in the neonatal period and most resolve by 18 months

Port-wine stain (Naevus Flammeus)

Mikhail_Gorbachev_2010

  • Less common than salmon-patches (~0.3% of newborns).
  • Usually large, flat patch of purple/dark red skin; well defined border; usually unilateral and commonly on the face (rarely does it occur on both sides of the body)
  • These don’t resolve spontaneous- usually become darker with age.
  • Though to be due to abnormal dilation of papillary dermal capillaries/venules (possibly due to deficiency in perivascular peripheral innervation)
  • Laser treatment can be used to try and lighten some naevi, although response is variable.  Laser treatment is only really used in infants with large, disfiguring naevi as the treatment itself can be scarring.

Strawberry naevus (Haemangioma)

Capillary_haemangioma

  • Benign lesion of proliferating vascular endothelial cells- very common (3-5% of babies, particularly premature, twin, white, female)
  • Can present at birth or up to a month post-natally, most occur on the head/neck
  • Most cause no symptoms or problems, but some may require removal depending on the site
    • Propanolol may also be used (as can steroids)
    • BUT most regress completely within a few years.
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