Birthmarks can be a distinguishing characteristic, a mark of beauty, or a cosmetic challenge. Many birthmarks are simply innocent pigmentation that may fade with time. But some can be more dangerous. Many variations of birthmarks exist, but two of the most common types are congenital nevi, or moles and hemangiomas, which are malformed blood vessels.
A Matter of Moles
There are different types of moles. Some moles don’t appear until a child is older. But moles that are present at birth — congenital nevi — have a higher risk of developing into cancer.
Congenital moles can change color over time. As more skin pigmentation develops, they become darker. “We need to watch congenital moles carefully because of their cancer risk,” says Albert Woo, MD, a pediatric plastic surgeon at St. Louis Children’s Hospital. “We especially worry about those moles that are very large, raised and have changes in pigment. We remove those earlier. However, many moles will stay the same for life and never cause problems. It’s difficult to predict which ones will cause problems later. That’s why we follow them closely.”
Dr. Woo says that nevi which are large or on an important region of the body, such as on the face, eyes or nose, can often be removed at an early age. “Some children have severe congenital nevi affecting their entire back and chest. This is something we try to address sooner rather than later. Doctors will wait to remove most moles until the child is a little older if possible — usually in the pre-teenage years.”
The term hemangioma is sometimes linked to more charming names such as stork bites, angel kisses or cherry spots. These birthmarks are usually noticeable in the first few weeks of life. They may start as a tiny spot but can grow rapidly for the first 1 to 2 years of life. Eventually, they tend to reach a plateau phase and begin to shrink. “Hemangiomas usually get better on their own without treatment,” Dr. Woo explains. “About 50 percent resolve by age 5 and 70 percent are gone by age 7. We only intervene to remove them in specific circumstances.”
Some birthmarks are obvious troublemakers while others are more subtle. “Some children can develop a large hermangioma around their eyes, affecting vision. We often deal with these right away,” Dr. Woo says. “Other babies may have just a dot on the nose that can grow and lead to deformity. That’s why we recommend following these birthmarks closely.”
In some cases, hemangiomas may have to be treated with steroids, laser therapy or plastic surgery.
Follow the Mark
Dr. Woo recommends that parents contact their pediatrician for any birthmark they’re concerned about. “It’s important to follow the progress of a birthmark because some become problems over time and we can’t always predict which ones these will be. A pediatric dermatologist should follow the birthmark and may recommend plastic surgery if necessary.”
In the rare instances where a birthmark isn’t simple, St. Louis Children’s Hospital offers a Vascular Lesions Clinic that treats more complex birthmarks and offers a multidisciplinary team of dermatologists, surgeons and interventional radiologists. The Vascular Lesions team has found new and innovative ways to treat some of these disfiguring lesions that are deep and involve muscles or nerves.
To set up an appointment, please call 314.454.KIDS or toll-free 800.678.KIDS.
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