Vascular Birthmarks

What is a vascular birthmark? All parents hope for new born children without visible imperfections. Nevertheless, some are born with or develop birthmarks soon after birth. These surface marks or abnormalities are commonly referred to as birthmarks.

Among such birthmarks is the hemangioma. The hemangioma is a red mark on the skin consisting of tiny blood vessels that are bunched together. Hemangiomas may occur anywhere on the skin. The size varies from minute to such a large growth that it may involve an entire leg or arm. Hemangiomas may vary in number from one to many hundreds. Although hemangiomas may be concealed by hair, or involve body parts that are ordinarily covered with clothes, they are sometimes obvious, such as those on the face.

What causes birthmarks? Why do hemangiomas occur at all? As with many other birthmarks, the exact cause is not known.

What kinds of birthmarks are there? There are many different types of birthmarks. A birthmark can occur from a defect in the epidermis, vessels, lymphatics, nerves or any of the appendages of the skin. There are many types of hemangiomas – the port wine stain, strawberry hemangioma and cavernous hemangiomas are the most common.

1. Port wine stains (PWS). Port wine stains are benign congenital vascular malformations occurring in approximately 0.3% of the population. They grow in proportion with the child and usually do not spontaneously regress. The vast majority of these lesions are found in the head and neck regions. At birth these lesions tend to be pale pink and flat. Unlike some other vascular lesions presenting in childhood, such as the capillary hemangioma (strawberry hemangioma) which tend to regress with time, PWS are permanent and progress to become dark pink to red to purple raised nodular lesions, sometimes increasing in size to cause asymmetry of the affected area. The psycho-social impact of the PWS should not be underestimated.

Although benign, PWS are relatively common and frequently disfiguring. They have been the focus of great effort in treatment. Surgery, cryotherapy, x-irradiation, electrocautery and tattooing are some of the treatments used to ablate these lesions. With advances in technology the newer vascular lasers have now become the treatment of choice for many vascular birthmarks.

2. Strawberry hemangioma (capillary hemangioma). This kind of vascular overgrowth is elevated above the surface of the skin and has a distinct border. Lesions 2 cm to 4 cm in diameter are most common, however they can involve an entire extremity. These growths can occur anywhere on the body and vary in number from one to hundreds.

The strawberry hemangioma can be present at birth or it may not appear until the first few months of life. It has a moderately rapid period of growth for approximately six months but occasionally as long as two years, when it may increase to several times its original size. Ordinarily the regression is very slow, taking up to five to seven years of age for them to spontaneously disappear. Little, if any, cosmetic defect remains after spontaneous regression.

3. Cavernous hemangiomas. The Cavernous Hemangioma is so named because the vessels comprising it are conglomerated beneath the surface of the skin, making it appear elevated and bluish in color. The cavernous hemangioma has no sharp margins. It feels like a doughy mass underneath the skin and is only partially compressible. Sometimes a strawberry hemangioma is superimposed on the surface of a cavernous one giving what is called a “mixed Capillary/Cavernous Hemangioma”.

The course of growth and disappearance is like that of a strawberry hemangioma, except the regression of the vascular element is not always cosmetically acceptable. This is because some of the overlying skin may remain as a soft hanging pouch, with or without vascular and fibrous elements beneath.

What treatment is available? It is important that birthmarks be examined by physicians who have expertise in hemangioma therapy so that a correct diagnosis and a decision about whether or not treatment is needed can be made early. Some hemangiomas mare best treated shortly after birth and others are best left alone.

Port wine hemangiomas and some visible capillary (strawberry) hemangiomas are best treated by vascular lasers now available at some laser centres.

Dr. B. Kent Remington