Term
| defining the term birthmark |
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Definition
a mark or lesion on the skin evident at birth or shortly thereafter
onset may be delayed (0-10 years)
usually not hereditary
often permanent |
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Term
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Definition
an excess, deficiency, or abnormality of one or more of the normal skin components of the skin:
-blood vessels, lymph vessels, pigment cells, hair follicles, sebaceous glands, epidermis, collagen, elastin |
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Term
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Definition
vascular
pigment cell
pigment |
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Term
| types of vascular birthmarks |
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Definition
salmon patch
port wine stain
hemangiomas |
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Term
salmon patch - nevus simplex
prevalence |
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Definition
-most commmon birthmark, especially of the vascular type
-30-40% of newborns |
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Term
salmon patch
type and location |
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Definition
flat, dull pink lesion
nape of neck, occiput, glabella, upper eyelids
forehead - characteristic V-shaped pattern |
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Term
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Definition
95% of non-nuchal fade with time
50% of nuchal lesions persist
benign, no tx needed |
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Term
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Definition
capillary malformation
dilated fetal capillaries |
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Term
port wine stain - nevus flammeus
etiology |
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Definition
| capillary malformation - dilated mature capillaries |
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Term
port wine stain
lesion and location |
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Definition
persistent, no involution
initially flat, pink/rose color
face, extremities; usually unilateral |
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Term
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Definition
| progressive darkening, thickening, nodularity |
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Term
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Definition
pulse dye laser
-targets hemoglobin |
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Term
| port wine stain associations |
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Definition
with certain distributions along the trigeminal nerve:
V1 & V2: glaucoma risk
V1: Sturge-Weber
soft tissue or bone overgrowth
with limb involvement: Klippel-Trenaunay |
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Term
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Definition
facial port wine stain in V1 distribution (+/- other areas)
CNS involvement
eye abnormalities |
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Term
hemangiomas
etiology and prevalence |
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Definition
benign vascular growth; proliferation of endothelial cells
often not seen at birth
female>male
preterm, low BW infants |
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Term
| natural course of hemangiomas |
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Definition
-rapid proliferative phase
-stabilization/plateau
-spontaneous slow involution |
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Term
| residual skin changes of hemangiomas |
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Definition
20-50% leave residual skin changes
-pallor, atrophy, telangiectasias, texture change
max of 50% regression by 5 years, 90% regression by 9 years |
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Term
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Definition
painful ulcerations of center position can occur
obstruction of vital function
psychosocial concerns
high output cardiac failure (rare in solitary cutaneous lesions) |
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Term
| problematic/high risk locations for hemangiomas |
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Definition
| lips, perineum, nose, caervicofacial/"beard", periorbital, parotid, ear, lumbrosacral |
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Term
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Definition
5 or more hemangiomas
benign and disseminated varieties |
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Term
| benign neonatal hemangiomatosis |
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Definition
no visceral involvement
benign course - rapid involution of lesions on their own |
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Term
| disseminated neonatal hemangiomatosis |
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Definition
hemangiomas of at least 3 separate organ systems
liver most common |
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Term
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Definition
active, non-intervention
local wound care, pain management
pulse dye laser
systemic corticosteriods |
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Term
| vascular birthmarks that may need further evaluation |
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Definition
-PWS in V1 distribution
-hemangiomas involving critical apertures (eyes, nose, mouth, urethra, rectum)
-very large hemangiomas
-multiple (>5) hemangiomas
-lesions overlying the midline or lumbosacral area |
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Term
| vascular birthmarks which may need treatment |
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Definition
-port wine stains
-ulcerated hemangiomas
-hemangiomas interfering with any vital function
-massive or multiple lesions associated with thrombocytopenia, coagulopathies, CHF
-lesions potentially cosmetically disfiguring |
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Term
| type of pigment cell birthmarks |
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Definition
dermal melanocytosis
cafe-au-lait macule
congenital melanocytic nevus
ash leaf macule |
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Term
dermal melanocytosis
etiology/prevalence |
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Definition
("Mongonlian spots")
melanocytes in dermis
>80% in African-American and Asian infants |
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Term
dermal melanocytosis
lesion and location |
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Definition
slate blue/gray/black
buttocks, sacrum |
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Term
dermal melanocytosis
course |
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Definition
benign
most fade by puberty
can be confused for child abuse |
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Term
cafe-au-lait macule (CALM)
etiology |
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Definition
normal number of melanocytes, but increased amount of melanin
present at birth or develop later |
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Term
cafe-au-lait-macule
lesion |
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Definition
flat, discrete
round/oval
light tan-brown
few mm to many cm in size |
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Term
| cafe-au-lait macule associations |
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Definition
most often without associations, but may be markers for genetic disease
5 or less: usually not significant
6 or more: consider neurofibromatosis
large with jagged edges: consider McCune-Albright syndrome |
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Term
congenital melanocytic nevus
etiology/prevalence |
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Definition
"birthmark mole"
nests of melanocytes
present at birth or within first year of life |
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Term
congenital melanocytic nevus
lesion |
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Definition
size definition based on estimated adult size: small, medium (1.5-20cm), large
variable color, border, surface, hair
may have increased dark hairs (making monitoring difficult) |
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Term
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Definition
melamona risk uncertain
management controversial, individualized |
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Term
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Definition
6-8% lifetime risk of melanoma
-greatest risk in first decade
-axial location higher risk
-increase number of satellite lesions higher risk
scalp, dorsal axis/lumbrosacral lesions (CNS risks)
needs individualized management |
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Term
ash leaf macule
etiology and prevalence |
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Definition
normal number of melanocytes, decreased melanin (opposite of cafe-au-lait)
present at birth or develop later |
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Term
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Definition
hypopigmented macules (UV Woods lamp may help to visualize on exam)
most 1-3cm with irregular margins
oval or "ash leaf shaped" |
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Term
| ash leaf macule associations |
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Definition
| 3 or more lesions = tuberous sclerosis |
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Term
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Definition
| neurocutaneous syndrome featuring classic triad of: seizures, mental deficiency, skin lesions |
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Term
| pigment cell birthmarks which may need evaluation |
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Definition
large lesions
multiple lesions
lesions overlying scalp, dorsal axis, lumbrosacral area (risk of underlying CNS manifestations) |
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Term
| pigment cell birthmarks which may need treatment |
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Definition
consideration of surgical excision of congenital melanocytic nevi based on many factors:
appearance and location - ease of observation, risk of melanoma, risks and ease of surgical removal, functional/cosmetic impact of surgery |
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Term
| types of epidermal birthmarks |
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Definition
epidermal nevus
nevus sebaceous
connective tissue nevus
aplasia cutis congenita |
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Term
epidermal nevus
etiology and prevalence |
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Definition
warty-like overgrowth of epidermis
present at birth or early chilhood (lesion may extend with time) |
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Term
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Definition
wart-like
often linear
solitary or extensive |
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Term
| epidermal nevus associations |
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Definition
| extensive lesions may be associated with CNS, skeletal, ocular, cardiac abnormalities |
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Term
connective tissue nevus
etiology and prevalence |
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Definition
increased dermal collagen and/or elastin
usually appear in childhood/adolescence
isolated defect or AD inheritence |
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Term
connective tissue nevus
lesion and location |
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Definition
flesh colored-yellow nodules or plaques
"cobblestone" or "oragne peel" surface
trunk>extremities
no malignant potential |
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Term
aplasia cutis congenita
etiology and prevalence |
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Definition
localized absence of skin
present at birth |
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Term
aplasia cutis congenita
lesion and location |
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Definition
most commonly at vertex of scalp
heals with thin scar
majority of small, typical lesions without associated abnormalities |
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Term
| epidermal birthmarks which may need evaluation |
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Definition
lesions that may be associated with a syndrome
large, extensive lesions
multiple lesions |
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Term
| epidermal birthmarks which may need treatment |
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Definition
nevus sebaceous consider excision
cosmetically disfiguring lesions
local wound care for aplasia cutis |
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Term
| in general, birthmarks which may require evaluation and/or treatment include: |
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Definition
large, extensive lesions
multiple lesions
lesions with increased malig potential
lesions that may be assc w/ a syndrome
PWS in V1 distribution
lesions overlying scalp, midline, L/S spine
lesions compromising a vital function
ulcerated or cosmetically disfiguring |
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