All About Birthmarks
by Susan Miller

Birthmarks come in a range of shapes, colours and sizes, and can appear anywhere on the body. Over 80 per cent of babies have some sort of birthmark. Most birthmarks fall into one of two main categories. Pigmented birthmarks involve a variation in the pigmentation of the skin, and vascular birthmarks are the result of extra blood vessels just under the surface of the skin. If your child is born with a birthmark or has one appear in the first few months after birth, check this out with your baby’s doctor so you know what to expect. Most birthmarks fade or disappear on their own in the childhood years.

The most common birthmarks:
 
Salmon patches
These blotchy pink or purple flat marks are seen on the nape of the neck, eyelids, forehead, and around upper lip and nose. Other terms used to describe this type of mark are “angel kisses” and “stork bites.” This is the most common type of birthmark and it appears on more than 70 per cent of infants. It is the result of dilated capillaries near the surface of the skin. In most cases these birthmarks fade away by the age of two, however the ones on the back of the neck usually last into adulthood. Salmon patches are more noticeable in children with fair skin and the patches can become more prominent when the child cries or when there is a change of temperature.

Hemangiomas
Hemangioma is a term that describes various blood vessel growths that can be flat or raised. Most are small and not very noticeable but some can be large and disfiguring. This type of birthmark is seen in two to five per cent of babies and is more common in girls, preemies and twins. Twenty percent of babies who have hemangioma have more than one. Most commonly, a hemangioma shows up in the first six weeks after birth, but 30 per cent of babies with this type of birthmark have them at birth. Hemangiomas are seen mostly on the head and neck.

A superficial hemangioma may be flat or raised in an irregular bumpy pattern. It often appears and grows rapidly, and can continue to grow through the first year. This benign blood vessel tumour is also known as a “strawberry mark”. This type of birthmark can grow to quite a large size before it begins to change colour and fade away. Treatment of a superficial hemangioma is rarely advised because 95 per cent shrink and disappear by the age of five. Sometimes a raised strawberry mark may bleed spontaneously, or when it is stretched or bumped. This is nothing to panic about, simply apply pressure and the bleeding will stop.

A deeper type of hemangioma often referred to as a cavernous hemangioma is a lumpy bluish-red mass. It also grows quickly in the first six months and is a bluish colour because the vessels are deeper than those in a superficial hemangioma. These are usually gone by the time the child reaches their teen years.

Mongolian spots
These spots are present at birth and are blue-green to slate grey in colour, round or oval in shape, and can resemble bruises. Typically Mongolian spots appear on the lower back or buttocks, but can also be on the legs or shoulders. Nine out of 10 children of Asian, East African, and First Nations descent will have these marks. They are also fairly common in infants of Hispanic or Mediterranean ancestry, but are rare in blond-haired, blue-eyed infants. Removal of these spots is never recommended because Mongolian spots fade almost completely by adolescence, but occasionally can persist into adulthood.

Cafe au lait spots
These are pigmented birthmarks that appear on any part of the body as flat coloured patches on the skin. This collection of extra pigment produces a permanent spot that is tan to light brown in colour (the colour of coffee with milk in it—hence the name). Twenty to 50 per cent of newborns have one or two of these cafe au lait spots at birth, or they may appear during the first few years of life. These spots should not be removed because the results of surgery are likely to be more disfiguring than the mark. If your child has one of these spots that is more than five millimetres wide, or has more than five spots speak to your doctor about this. Café au lait spots usually fade or get smaller as the child grows although they may darken with sun exposure.

Port-wine stains
About one in 300 infants is born with this purplish-red birthmark that may be on any part of the body, but is most often found on the face, neck or extremities. These birthmarks can be flat or slightly elevated. Over time they may change in colour slightly, but do not fade much, and are considered permanent—some may even thicken or darken with age. In the past only cosmetic creams were available to conceal these marks. Today there is pulsed-dye laser treatment to correct this cosmetic condition. A dermatologist will perform this treatment which can begin as early as a few weeks after birth, and may require a general anaesthetic. Six to nine laser treatments may be needed over time to completely remove the mark.

Moles
About one per cent of babies are born with a mole, but most moles develop in children from five to 10 years old. They are usually light brown to blackish, slightly raised and may be hairy. Small moles are common. Large hairy moles are less common and tend to get hairier and darker with age and should be carefully watched for any changes. It is often advised that these large hairy moles be surgically removed as there is a potential for them to become malignant.

It can be hard for parents to deal with a birthmark on their baby, especially if it is a large or disfiguring one on the face or head. It is understandable that you would want something done about it. In most cases, however, the birthmark will resolve naturally on its own. In the meantime, find out all you can about the type of birthmark your baby has and discuss your questions with your baby’s doctor.

You might also find it helpful to talk with other parents who have dealt with the birthmark situation. Have an explanation ready for those who will ask you about your baby’s birthmark. As we all know, little children are inquisitive and can be very forward with their comments and questions. A simple but honest explanation is all that is required. On the other hand, adults who are nosy or insensitive probably deserve the sharp retort you have ready for them!

Susan Miller R.N. BScN is a Perinatal Educator and Certified Breastfeeding Counsellor. She teaches, coordinates and develops prenatal, post-natal and early parenting programs in the Greater Victoria area.