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Birthmarks and Skin Anomalies (Nevi, Hemangiomas and Vascular Malformations)
Gillette’s Center for Craniofacial Services uses advanced surgical and laser therapy techniques to repair a variety of birthmarks and skin anomalies, including hemangiomas, venous malformations and vascular malformations, such as port-wine stains and telangiectatic nevi.
Our program medical director—one of the nation’s most experienced craniofacial surgeons—helped pioneer current surgical methods used to remove facial masses. We focus on providing children with the best cosmetic outcomes possible while promoting their well-being and self-esteem.
Why Choose Gillette?
- Our craniofacial and plastic surgeons are the region’s top experts in repairing nevi, hemangiomas, port-wine stains, and other skin anomalies in children.
- We offer innovative treatment techniques, including endoscopic plastic surgery, laser therapy and microsurgery.
- Our long-pulse laser penetrates the skin and larger blood vessels better than traditional lasers do, resulting in better outcomes.
- We offer effective treatments for even the most aggressive skin lesions.
Birthmarks and other types of skin anomalies occur when blood vessels—arteries, veins, lymphatic vessels or capillaries—develop abnormally. Birthmarks are relatively common, occurring in approximately 10 percent of all babies.
Although most birthmarks are harmless, more serious anomalies (including some hemangiomas and certain types of vascular malformations) require treatment. Our craniofacial and plastic surgeons provide evaluations, diagnostic tests (including angiography and magnetic resonance imaging), and treatments to significantly reduce, or eliminate, many types of skin lesions.
Types of Birthmarks and Skin Anomalies
There are many types of birthmarks and skin anomalies. Many do not require treatment and might even disappear over time. Our craniofacial and plastic surgeons evaluate and diagnose babies who have skin abnormalities to determine if treatment is needed. The two main types of lesions that may require medical attention are hemangiomas and vascular malformations.
Hemangiomas are benign (noncancerous) tumors of the blood vessels. They may or may not appear at birth, but they always become visible within one to four weeks after birth. Because hemangiomas often appear as bright red or pink lumps, some people refer to them as “strawberry marks.” Hemangiomas that reach deeper into the skin may appear blue.
Hemangiomas usually occur on the head or neck, but they can occur anywhere on a child’s body, including the internal organs. The tumors first appear as skin discolorations; later they become darker and raised. Some hemangiomas exist only on the skin’s surface, while others reach into the skin’s deeper layers, resulting in a spongy texture.
Vascular malformations are abnormal collections of blood vessels. Unlike hemangiomas, vascular malformations are permanent. They grow as children grow. The most common types are port-wine stains and telangiectatic nevi, although more unusual variations also exist.
Port-wine stains are flat, reddish or purplish birthmarks that usually appear on the face and are visible at birth. Like hemangiomas, port-wine stains can appear anywhere on the body. As children grow, the skin near a port-wine stain often thickens, and the discoloration becomes more prominent. Untreated port-wine stains can become raised and bleed easily when injured. When port-wine stains appear near the forehead, cheekbones and eye, Sturge-Weber syndrome might be present. That syndrome is associated with malformations in the blood vessels of the face and/or brain and with intraocular pressure (glaucoma).
About 30 to 50 percent of newborns have flat, pink spots on their skin. Such spots are called telangiectatic nevi—often referred to as “stork bites” or “angel kisses.” The spots appear on the face and neck, eyelids, upper lip, back of the neck, and forehead. When babies cry or when their temperatures rise, the spots might become redder. These spots often become lighter, or even disappear, as children grow older. If nevi persist, however, they can become more obvious, possibly affecting the appearance or function of other nearby structures, such as an eyelid or lip.
Other Vascular Malformations
- Venous malformations are deep-vein abnormalities. Such malformations appear as bluish lesions on the skin. Although venous malformations are typically present at birth, some might not become visible for years.
- Lymphatic malformations are masses, typically in the head or neck, that result from abnormally formed lymphatic vessels. Such malformations interrupt the normal pathway of the lymph system, causing the vessels to dilate. The dilation results in swelling and, sometimes, enlarged tissues and bones.
- Arteriovenous malformations are defects of the circulatory system. Abnormal connections between arteries and veins create such malformations. They can be localized lesions (most commonly on the head and neck) or diffuse lesions (usually on the chest, abdomen or limbs). They also can occur on the organs, particularly in the brain.
Causes of Birthmarks and Skin Anomalies
Causes and risk factors for skin anomalies vary based on the type.
Hemangiomas result when cells migrate with abnormal speed, creating enlarged capillaries around the tumor and increasing the size and appearance of the hemangioma. Though experts don’t know what causes hemangiomas, we know they occur in approximately 7 percent of the population. They occur primarily in Caucasian children, and they are more common in premature babies and females.
Although most hemangiomas will gradually disappear without treatment, others can interfere with a child’s ability to function. A lesion on the eye, for example, can irreversibly damage a child’s vision; a growth in the throat can affect a child’s breathing. Facial hemangiomas can be disfiguring. Hemangiomas that occur deeper in organ systems—such as the liver, colon or brain—also require treatment.
Although the types of vascular malformations vary, they all occur when blood vessels develop abnormally. Port-wine stains, for instance, develop because the affected area of the skin lacks the small nerve fibers needed to narrow the vessels. Similarly, telangiectatic nevi occur because of how certain blood vessels form in utero. There is no known genetic cause of vascular malformations.
Because vascular malformations continue to grow as a child grows, treatment is usually necessary to slow the lesion’s development and prevent long-term effects. Left untreated, many vascular malformations will darken and thicken as a child grows.
Symptoms and Diagnosis of Birthmarks and Skin Anomalies
Most birthmarks and skin anomalies are evident at birth or become visible several weeks after birth. Easily visible abnormalities will often be evident in the delivery room or newborn nursery; a baby’s parents or pediatrician might notice other types later.
We prefer to see infants with skin abnormalities as soon as possible—if necessary, before they leave the hospital nursery. That’s especially true if the lesion appears on the face or near a functional area such as the nasal passage or eyes, where it could impede the airway or vision.
Early intervention enables us to diagnose the lesion and determine an effective treatment plan as early as possible. Our surgeons and nurse practitioners have practice privileges at most hospitals in and around the Twin Cities.
Treatments for Birthmarks and Skin Anomalies
Many birthmarks and skin abnormalities, such as telangiectatic nevi and certain hemangiomas, do not require intervention and may disappear over time. They should, however, be examined regularly to make sure there is no rapid growth or change in the lesion.
When treatment is necessary because of the location or severity of a child’s skin anomaly, our craniofacial and plastic surgeons often use laser therapy. Our long-pulse dye laser penetrates the skin and larger blood vessels better than traditional lasers do, reducing the abnormalities more completely.
We might use medications (including propranolol therapy or oral or injected steroids), sclerotherapy (medicine injected into the vessels to make them shrink), or embolization (a treatment that blocks the flow of blood in small blood vessels). Sometimes reconstructive surgery is necessary to effectively treat skin lesions.
Our Birthmark and Skin Anomaly Services
Gillette offers the region’s leading experts in pediatric craniofacial and plastic surgery. We use the latest surgical and laser therapy techniques to treat even the most complex skin anomalies. We know that successful intervention early in a child’s life can prevent future complications, ensuring the best possible medical and cosmetic outcomes.
A patient's care team most often includes specialists in:
Publications and Resources
Publications for Health Care Professionals
- Propranolol Is Treatment of Choice for Facial Hemangiomas or Those That Impair Function (A Pediatric Perspective, 2011) (PDF)
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