All About Birthmarks

by Susan Miller, BScN

Birthmarks come in a wide range of shapes, colours and sizes, and can appear anywhere on the body. Over 80 per cent of babies have some sort of birthmark, with most falling into one of two main categories. Pigmented birthmarks involve a variation in the pigmentation of the skin, and vascular birthmarks involve 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 with your baby’s doctor. Most birthmarks fade or disappear on their own in the childhood years.

The most common birthmarks are:

Salmon patches
These blotchy pink or purple flat marks appear on the nape of the neck, eyelids, forehead, and around the 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. Salmon patches are the result of dilated capillaries near the surface of the skin. Usually these birthmarks fade 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.

Haemangioma
Haemangioma describes blood vessel growths that are bright red and 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 per cent of babies who have haemangioma have more than one. Most commonly, a haemangioma shows up in the first six weeks after birth, but 30 per cent of babies with this type of birthmark have them at birth. Haemangioma are seen mostly on the head and neck.

A superficial haemangioma may be flat or in a raised 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” and can grow quite large before it begins to change colour and fade away. Treatment of a superficial haemangioma 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 haemangioma often referred to as a cavernous haemangioma is a lumpy bluish-red mass. It also grows quickly in the first six months and is a more bluish colour because the vessels are deeper than those in a superficial haemangioma. These are usually gone by the time the child reaches the 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. Mongolian spots typically appear on the lower back or buttocks, but can also be on the legs or shoulders. Nine out of 10 children of Asian, East Africa, 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, though occasionally can persist into adulthood.

Café au lait spots
These are pigmented birthmarks that appear on any part of the body as flat creamy coffee coloured patches. This collection of extra pigment produces a permanent spot that is tan to light brown in colour. Twenty to 50 per cent of newborns have one or two café au lait spots at birth, or they may appear during the first 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. 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 usually 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. These marks may even thicken or darken with age. In the past only cosmetic creams were available to conceal these marks. Today pulsed-dye laser treatment can correct this cosmetic condition. A dermatologist will perform this treatment which can begin as early as a few weeks after birth, however in cases where the procedure requires a general anaesthetic parents are usually advised to wait until the child is older to have it done. Six to nine laser treatments may be needed over time to completely remove the stain.

Moles
About one per cent of babies are born with a mole, but most moles develop in children from five to 10 years of age. They are usually light brown to blackish in colour 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 large hairy moles be surgically removed as there is a potential for them to become malignant.

Parents’ Feelings
It can be hard for parents to deal with a birthmark on their baby, especially if it is large or disfiguring on the face or head. It is understandable that you would want something done about it. In most cases however the birthmark will resolve itself naturally. 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 birthmarks. Have an explanation ready for those who ask you about your baby’s birthmark. Little children are inquisitive and can be very forward with their comments and questions. A simple but honest explanation is all you need. On the other hand, nosey or insensitive adults probably deserve the sharp retort you have ready for them!

Susan Miller R.N. BScN is a Perinatal Educator and Certified Breastfeeding Counsellor and has worked with pre and post-natal families in Greater Victoria for 30 years. She and her husband have just welcomed a second granddaughter born to their son and his wife in Calgary.