Birthmarks are skin lesions that are present either at birth or appear shortly thereafter. There are 2 major types: melanocytic or pigmented (brown or dark brown) and vascular (red, pink or purple)

Most lesions are flat and small, however rarely they can be several inches in diameter and very thick. In rare cases, babies have large vascular lesions near the eye or mouth which can interrupt normal development. Large vascular lesions can be a sign of underlying neurological disease or serious blood diseases. Also, large melanocytic lesions can be disfiguring and put the child at risk for neurological disease and/or future cancer.

Pigmented or Melanocytic Birthmarks include moles or nevi called congenital nevi and are classified as 1) small, under 1.5cm in diameter 2) medium, from 1.5cm to 20cm and 3) large, over 20cm. Generally speaking, the larger the lesion, the greater the risk of internal disease and future melanoma risk. Very large lesions may be associated with mole cells on the brain and spinal cord or a high risk of future melanoma.

Other lesions are flat and do not confer a risk of other diseases. These include Mongolian spots, which look like bluish/brown bruises and appear more frequently on the backs of people with darker skin.

Some lesions, such as café-au-lait (CALM) spots that are flat, light brown or tan and normally are isolated. However, in the right context, CALM lesions can be part of genetic syndromes.

In general a dermatologist should evaluate larger or irregular birthmarks concerning to a pediatrician and if necessary, follow them carefully throughout development.

Vascular Birthmarks develop before or shortly after birth and are comprised of blood vessels. There are a number of different types:

·         Hemangiomas- These are red to purple lesions (from small bumps to large irregular masses) made of small blood vessels and can range from small and insignificant to massive, disfiguring and even life-threatening. One-third of them are present at birth and the rest appear within a month after birth. They may grow for up to 18 months and then normally begin to disappear. Treatment is geared towards limiting functional impairment (i.e. lesions on the nose or lips) or cosmetic disfigurement. In rare cases, babies with multiple lesions may need a systemic workup to look for internal hemangiomas. Treatments range from medications to shrink the lesions (i.e. propranolol) to laser to destroy the blood vessels and improve the appearance.

·         Port Wine Stains- These are normally flat lesions that are relatively common (3 out of 1000 births) and appear on the head and neck. When they occur on the face, they can be disfiguring and lead to psychological problems. They do not disappear over time, and can become elevated from the skin leading to a thickened or “lumpy” appearance. They are given names such as “stork bite” when present on the base of the scalp/back of the neck or “angel kisses” when on the upper eyelid. A large lesion on the face may also be a sign of a neurological disease call Sturge Weber Syndrome and warrant investigation with a neurologist. The best treatment is vascular laser (pulsed-dye) which results in permanent reduction of blood vessels. Also, cover up make-up can be helpful for temporary camouflage.

·         Arteriovenous malformations- These are abnormal growths of blood vessels that can be either low flow or high flow and are present at birth. As the lesions grow, the vessels enlarge and thicken—the lesions are often firm masses. They can be made of vein (venous) arteries (arterial) or mixed (arteriovenous or AV). Treatment may be necessary depending on location, size and the amount of blood flow travelling through them.

·         Associated diseases- Vascular birthmarks can be a sign of underlying disease including internal hemangiomas, brain malformations, seizures, spinal cord diseases, and blood loss.

For more information, visit the Vascular Birthmark Foundation’s website:

http://www.birthmark.org