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Birthmarks appear in a variety of shapes, sizes, colors, and textures on or under the skin. They may be present at birth or appear during the first year or two of life.
Birthmarks are common: More than 10 percent of babies have a birthmark of some type. Dermatologists at Hassenfeld Children’s Hospital at NYU Langone can determine the type of birthmark based on a visual examination of your child’s skin.
For the most part, birthmarks are harmless, and some may fade or disappear over time even without treatment. Rarely, some types of birthmarks may be signs of a more serious medical condition. This is more likely if birthmarks develop in large numbers or in clusters.
Vascular birthmarks are often red and may be raised or flat. Some can grow to cover large areas of skin. Certain types of vascular birthmarks are present at birth. Others may develop within the first few weeks of a baby’s life.
Hemangiomas affect as many as 1 in 20 newborns. Girls are three times as likely to have them as boys, and babies born prematurely are at an increased risk of developing this type of birthmark. There are two common types of hemangiomas: strawberry hemangiomas and deep hemangiomas.
Strawberry hemangiomas are named for their bright red color. They appear on the surface of the skin and can be flat and splotchy or look like raised, hard bumps.
Strawberry hemangiomas that are located near a body opening or body fold may be at a higher risk of ulceration, which means the surface of the birthmark becomes an open sore. In some instances, blood or pus may ooze out of the hemangioma and require evaluation by a doctor.
Deep hemangiomas form in deeper layers of the skin and appear as raised blue–gray bumps. This type of birthmark may only become obvious weeks or months after a baby is born, when it starts to show on the skin’s surface.
Most of the time, hemangiomas grow rapidly during the first year of a baby’s life. Then they flatten out and slowly fade. Many hemangiomas disappear completely by the time a child is 10 years old, although some may leave light discoloration or rippled texture on the skin.
Some hemangiomas can damage surrounding skin and soft tissue—for example, if a hemangioma develops on the lip or eyelid—and our dermatologists may recommend medical or surgical intervention to avoid disfigurement in these sensitive areas.
Groups of hemangiomas may appear in a “beard” pattern around a child’s mouth and chin or on one side of the face. They may also appear as multiple small, raised birthmarks that resemble pencil erasers spread across the skin.
Children with these types of hemangioma patterns may also have hemangiomas develop on organs or other structures inside the body. In these instances, dermatologists may recommend imaging studies to determine if any hemangiomas have developed on the inside of the body and if treatment is necessary.
Salmon patches are harmless clusters of blood vessels that create small, flat, pinkish-red marks. These birthmarks, also called vascular stains, can appear on any area of the body.
When salmon patches appear at the back of the neck, they are sometimes nicknamed “stork bites” and are often permanent, though they are easily covered by hair and become barely noticeable as children age.
Salmon patches may also appear on the center of the face, including the forehead, eyelids, or lip. These are sometimes nicknamed “angel’s kisses” and almost always fade as the baby grows. Salmon patches rarely require treatment.
Port Wine Stains
Port wine stains are less common than hemangiomas, and are usually present at birth. Port wine stains are commonly found on the face.
Initially appearing as flat pink or red areas on the skin, port wine stains can darken to a deeper red or purple color over the years. The underlying skin may become thicker. These birthmarks may also increase in size as children grow.
Rarely, port wine stains are associated with a medical condition called Sturge-Weber syndrome, which carries an increased risk of glaucoma, a condition that leads to increased eye pressure. Sturge-Weber syndrome may also cause seizures due to an abnormality of blood vessels in the lining covering the brain. The risk of this condition is highest in babies who have port wine stain birthmarks covering half of the face or more.
Venous Vascular Malformations
Venous vascular malformations are birthmarks that appear as a result of groups of veins that are unusually dilated, or enlarged. Dilation makes the veins more visible and gives venous vascular malformations a red or purple appearance.
This type of birthmark may appear at birth through late childhood. Venous vascular malformations tend to grow slowly and don’t fade on their own. Our dermatologists can identify a venous vascular malfunction and help guide the appropriate treatment for your child.
Café-au-lait spots are named for their light brown color: “Café-au-lait” means “coffee with milk” in French. Although some are present at birth, most café-au-lait spots appear well after a child is born.
They are relatively common—as many as 30 percent of children have a café-au-lait birthmark by age 6. Café-au-lait birthmarks vary in size and are often round or oval in shape. These birthmarks form when skin cells produce an excess of melanin, which is the body’s natural pigment.
Café-au-lait birthmarks generally don’t fade and may get bigger or darker over time. Most are harmless. However, the presence of 6 or more, regardless of their location on the body, may be linked to a genetic medical condition called neurofibromatosis type 1. If your child has 6 or more café-au-lait spots, our dermatologists may recommend additional testing.
Dermal melanocytosis birthmarks, once commonly known as Mongolian spots, are flat blue–gray patches that are usually present at birth and appear most frequently on the lower back and buttocks. These spots vary in size and tend to fade during the first few years of a child’s life. They occur as the result of pigment cells making melanin below the surface of the skin and do not require treatment.
When these types of birthmarks appear on the face or shoulder, they may be permanent but can respond to laser treatment.
Congenital nevi are moles that are present at birth. These moles are different from moles that are acquired due to sun exposure. They are often larger, may have hair sprouting from them, and may appear on any part of the body. These moles may range from light to dark brown or almost black. They have a flat or bumpy texture.
Most moles present at birth are harmless. However, if many small moles are present at birth, they may indicate an excess of pigment cells growing in the central nervous system, which may lead to pressure on the brain and seizures if left unchecked. A dermatologist should evaluate your baby if many small moles are present at birth.
Moles that develop later in life may be related to a type of skin cancer called melanoma, whereas moles present at birth are less commonly associated with skin cancer. The risk of cancer developing later in life is higher if a baby is born with a mole that is larger than 8 centimeters. In this instance, a dermatologist examines the mole and determines if additional testing is necessary.
Sebaceous nevi are present at birth and most commonly located on the scalp. They form as a result of an overgrowth of sebaceous glands, which secrete a waxy substance called sebum that moisturizes skin and hair.
These birthmarks are usually tan or orange in color. They often appear as a long oval or comma shape. Sebaceous nevi do not fade over time, and hair cannot grow in the skin where they are present.
A small percentage of sebaceous nevi may become cancerous. Even though the risk is low, our dermatologists may recommend regular examinations to ensure that any change in the birthmark is noticed.
In some instances, a doctor recommends surgical removal of the birthmark. This is most common in adolescents, as hormones associated with puberty may activate the glands in the birthmark and increase the chance of skin cancer developing.
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