Topic Overview

Birthmarks are coloured marks on the skin that are present at birth or develop shortly after birth. They can be many different sizes, shapes, and colours, including brown, tan, black, blue or blue-grey, pink, white, red, or purple. Some birthmarks appear on the surface of the skin, some are raised above the surface of the skin, and some are located under the skin. Most birthmarks are harmless and do not need treatment. Many birthmarks change, grow, shrink, or disappear. There are many types of birthmarks, and some are more common than others.

Salmon patches (also called stork bites, angel kisses, or macular stains) are the most common type of birthmark. They are thin, flat, light pink or red areas of coloured skin that occur most frequently on the back of the neck (stork bites) and on a baby's upper eyelids, upper lip, or between the eyebrows (angel kisses). Most salmon patches on the eyelids fade without treatment within the child's first year. Most salmon patches on the nape of the neck do not fade. Salmon patches are more noticeable when a baby is crying or when he or she is hot or cold.

Congenital moles (nevi) are present at birth and are usually brown in colour. They can appear anywhere on the body and can be different shapes and sizes. Some moles appear alone, and some moles appear in groups. Large moles may need to be closely watched because they can become cancerous later in life.

Café-au-lait spots are smooth birthmarks that may be present at birth but tend to develop in childhood. They are usually oval in shape and range from light brown to chocolate brown in colour. They are found most commonly on the torso, buttocks, and legs. Café-au-lait spots do not go away, may increase in number, and generally do not require treatment. A single café-au-lait spot is not a sign of a health problem. But six or more spots that are larger than 6.5 mm (0.25 in.) or ones that occur along with freckles in the armpit or groin can suggest neurofibromatosis.

Mongolian spots are smooth, blue or blue-grey birthmarks that usually are found across the lower back and buttocks. They tend to occur in children of Asian, Southern European, Hispanic, Pacific Island, or African descent. A child may have one or several Mongolian spots. These types of birthmarks usually disappear without treatment by age 3 or 4.

Port-wine stains are pink-red at birth and darken to a red-purple colour after a few years. Port-wine stains are caused by blood vessels that do not develop normally. They can be small or they can cover a large area of the body. They generally are found on the face but can occur anywhere on the body. Port-wine stains on the face can be associated with brain problems caused by Sturge-Weber syndrome.

Port-wine stains do not fade or go away on their own and most darken, thicken, and form bumps during adulthood. Port-wine stains may become more obvious when the body's hormones are changing, such as during puberty or pregnancy. Laser therapy may lighten or reduce the bumpiness of port-wine stains. If a port-wine stain makes you or your child feel shy or self-conscious, ask your doctor about treatment options and/or support groups and counselling.

Hemangiomas are formed by a clump of immature blood vessels. They may be present at birth or may appear when a baby is several weeks old. Hemangiomas vary in size. They may be a few millimetres to a few centimetres in diameter. There are three basic types of hemangiomas:

• Superficial or capillary hemangiomas are the most common type. They are thick, raised birthmarks that are soft, purplish red, smooth, or slightly bumpy. They may be irregular or round in shape and most often are on the face, scalp, back, or chest. These hemangiomas may never grow, may grow slowly, or may grow rapidly to many times their original size in just a few months. After they stop growing, they usually begin to shrink. And most of them go away.
• Deep hemangiomas are thick, deep, raised birthmarks that can be pale, skin-coloured, red, or blue. They often are round in shape and may feel like a sponge. Deep hemangiomas may not go away, or they may fade and leave a scar.
• Compound hemangiomas are a combination of superficial and deep hemangiomas.

Some hemangiomas disappear completely by 18 months. Most hemangiomas disappear or fade by age 9. Most children who have hemangiomas have only one.

Few hemangiomas need treatment. But ones that grow rapidly or cause problems with sight, breathing, hearing, speech, or movement may need treatment. For example, babies born with severe hemangiomas that are growing rapidly need to be treated right away. And hemangiomas that grow on internal organs such as the stomach, intestines, liver, or kidneys may need treatment.

In rare cases, a hemangioma in the diaper area will become sore and bleed (ulcerate). Ulceration can be very painful. If this happens, apply pressure to the area continuously with a clean pad for 10 minutes. And contact your doctor for more advice and an appointment.