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What to Do About Birthmarks

When Nicholas Barinaga was 3 days old, his parents noticed a small, salmon-colored spot on his cheek. But instead of fading, it started getting redder. At his two-week checkup, the pediatrician told them it was a hemangioma -- a type of birthmark that could continue to grow. "It got worse quickly -- within a couple of weeks, the hemangioma was 6 inches long and 3 inches wide, and it had become bright red and thick like jelly," says his mother, Corinne, of Vancouver, Washington. He took oral steroids for several months and then had a series of laser treatments over the course of a few years. The results were truly amazing. "There's still some minor color distortion on Nicholas's cheek, but most people don?t even notice it," says Barinaga.

Hemangioma: Who's at Risk?

An estimated 4 to 10 percent of infants will develop a hemangioma in the first weeks after birth. They're more likely in Caucasians, girls, twins, infants born to older moms, and preemies -- 20 percent of whom may have one. Unlike moles, which are caused by pigmentation on the skin, hemangiomas are caused by an abnormal cluster of blood vessels beneath the skin, and they're usually found on the head or neck.

Most hemangiomas are relatively small lumps of pink- or red-colored tissue, sometimes called strawberry marks. "There's a tremendous range -- from teeny tiny ones that are completely innocuous to huge ones that take up half a baby's face," says Ilona Frieden, MD, clinical professor of dermatology and pediatrics at University of California, San Francisco School of Medicine, and a leading researcher. Once hemangiomas appear, they grow rapidly for several weeks to months, and then they flatten, fade, and grow smaller over the next five to 10 years.

Since most hemangiomas eventually shrink, pediatricians have traditionally recommended simply waiting for them to go away. (In fact, this conservative approach was in part a reaction to past aggressive treatment: In the 1930s and 1940s, children with hemangiomas were often treated with radiation, and doctors later realized this could cause cancer.) However, five or 10 years can be a long time to wait -- and some children may still be left with a scar or loose, stretched skin that looks like a deflated balloon, says Dr. Frieden. That's why experts are increasingly recommending treatment or surgery for big hemangiomas sooner rather than later -- for both medical and psychological reasons.

Milton Waner, MD, a hemangioma specialist at Roosevelt Hospital, in New York City, is an outspoken advocate for earlier intervention because he thinks that having a scar is much less traumatic for a child than walking around with a large hemangioma. "Children develop their sense of self by age 3, so we want to help them look normal by then -- certainly by age 5, when they're in school," says Dr. Waner.

As many as one in 10 hemangiomas are serious enough that parents should consult a specialist as soon as possible. These include protruding ones near the nose, eyes, lips, or diaper area; ones that cover a wide territory of skin; and those that ulcerate and bleed. Children who have five or more hemangiomas of any size should have more evaluation because they have a higher risk of also having internal hemangiomas, especially in the liver.

Steroid medication (either oral or injected) is one of the main treatments to reduce the size of a large hemangioma. Parents may worry about side effects, such as suppression of the immune system or slowed growth, but doctors say that the benefits outweigh them -- and that there's a limited window of time to intervene while a child's hemangioma is still enlarging. "Steroids are extremely effective, and they rarely cause any complications," says Parents advisor Amy Paller, MD, chief of dermatology at Northwestern University Feinberg School of Medicine, in Chicago. When steroids don't work, doctors may also use two cancer drugs -- interferon or vincristin -- or laser treatments. Lasers are often used to "mop up" leftover blood vessels or to fade the red color on flat hemangiomas that are on the face. Doctors may recommend surgery for large hemangiomas whose removal won't leave prominent scars or when a hemangioma?s growth is endangering a child's eyesight or breathing.

Waiting It Out

By the time Amber Bergeron was 3 months old, the hemangioma on the side of her nose had grown from a tiny scratch to the size of a grape -- and an ophthalmologist worried that it was obstructing her vision.

Her father, Peter, a center fielder for the Philadelphia Phillies, happened to meet another player whose daughter had a similar growth on her face. He suggested that the Bergerons contact the Vascular Birthmark Foundation, which referred them to Dr. Waner, in New York City. Dr. Waner recommended that Amber have the growth removed because it was so close to her eye, and she had the surgery when she was 4 months old. "She's now 21 months and looks beautiful," says her mother, Jennifer. "She healed faster than we ever thought she would."

Often it's parents who are most troubled by the birthmarks. After all, everyone envisions having a perfect baby, and other people's reactions can be upsetting. "When we went out in public, strangers would stare and make comments like, 'What happened to your baby?' " says Lisa Aires, of Berkeley Township, New Jersey, whose daughter, Kristen, had a birthmark the size of a quarter on her scalp. After consulting with different doctors, she and her husband decided not to treat the hemangioma, and when Kristen was 11 months old, it began to shrink. By the time she was 2, her hair had grown enough to cover it.

Fortunately, there are multidisciplinary medical groups springing up at major children's hospitals focused on these sorts of birthmarks, and more pediatricians are updating their attitudes about them. "While the Internet can provide useful information, many Web sites scare parents because they focus on the most severe cases," says Dr. Frieden. "It's actually reassuring to remember that most hemangiomas don't grow large and won't need any treatment."

Cafe-au-lait spots
What they look like: Flat patches that are tan or brown.
How common: Ten to 20 percent of newborns have one.
Should you treat or remove? No, they're generally too innocuous, even though they can grow as a child gets older. Having six or more cafe-au-lait spots larger than a quarter may be a sign of neurofibromatosis (a genetic disorder that causes abnormal growth of certain tissues).

Congenital nevi (moles)
What they look like: They may be brown or black, flat or raised, smooth or hairy.
How common: Most kids develop moles as they age, but only 1 percent of children have them at birth.
Should you treat or remove? Possibly. Dermatologists usually recommend removing large ones during the first years of life because there is a 5 to 10 percent risk that they will become cancerous.

Mongolian spots
What they look like: Blue or gray flat patches, often found on the lower back or buttocks.
How common: Most Asian babies and many African-American and Hispanic babies have them.
Should you treat or remove? No. They usually fade with time.

Macular stains
What they look like: Faint red patches on the forehead, eyelids, nose, or upper lip ("angel's kisses"), or on the back of the neck ("stork bites").
How common: Thirty to 50 percent of babies have one.
Should you treat or remove? No. These usually disappear by age 2, although ones on the neck may last longer.

Port-wine stains
What they look like: Flat pink, red, or purple spots. They grow, and often darken, with age. Ones on the forehead, eyelids, or both sides of the face can be linked to glaucoma and seizures, and they must be evaluated.
How common: Three out of 1,000 people have one.
Should you remove? Possibly. Laser therapy lightens marks on the face.

Find online support groups and referrals to specialists near you with these resources.

  • The Hemangioma Treatment Foundation

    Hemangiomatreatment.org
  • National Organization of Vascular Anomalies

    Novanews.org
  • Vascular Birthmarks Foundation

    Birthmark.org

Copyright © 2007. Reprinted with permission from the July 2007 issue of Parents magazine.