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About Birthmarks

Vascular birthmarks are categorized into two groups: (1) Vascular Tumors, of which hemangiomas are the most common, and (2) Vascular Malformations. Use the tabbed menu system below to view our resources on the most common conditions Dr. Levitin treats at the Vascular Birthmark Center.

Vascular Tumors

Hemangiomas are the most common tumor of infancy and typically appear within the first few weeks of life. They may then proliferate or grow for up to twelve months before undergoing a slow process of involution or regression. There is no known genetic cause, but hemangiomas are quite common, occurring in 1 in 10 Caucasian births. They are more common in females, twins, patients with light skin, and are associated with low­ birth weight or premature births.

 

Although they can occur anywhere on the body, more than 60% occur on the head and neck The majority of hemangiomas present as a focal or solitary lesion, or they may also develop in a segmental distribution, occurring over a large area of the face or body. Hemangiomas of the skin that appear flat and red are called superficial hemangiomas, while those that grow beneath the top skin layer are called deep hemangiomas, and may not be initially evident until later when they have grown to a noticeable size. Finally hemangiomas that involve both the superficial skin layer and the tissue below are called compound hemangiomas.

 

While most hemangiomas remain small, the growth patterns for hemangiomas are quite variable, and some hemangiomas may grow within critical areas that can be life­ threatening or cause functional impairment of vision, breathing, eating or hearing. It is therefore recommended that a vascular birthmark specialist be consulted immediately for any patient where there is a suspicion that a hemangiomas is causing noisy breathing, or compromise of the eyes, nose, mouth or ears. Furthermore, patients with rapidly growing hemangiomas, hemangiomas that develop ulcerations, or patients presenting with multiple hemangiomas (ie more than 5) should also be evaluated by a specialist for possible early intervention.

 

At the Vascular Birthmark Center, our philosophy is to provide prompt evaluation, confirm the diagnosis, and discuss appropriate treatment options to ensure that every patient has the opportunity to be treated in a timely and effective manner. While in the past many doctors thought hemangiomas would simply "disappear" over time if left alone, it is now known that most children with hemangiomas on the face will require some form of treatment in order to achieve an acceptable cosmetic result. For many children requiring surgery, this can now be done before the end of the first year of life, restoring the face and/or body to normal appearance, thus allowing the child to grow up and develop a normal sense of self­ awareness.

 

Hemangiomatosis is a condition characterized by diffuse infantile hemangiomas, and may be associated with visceral hemangiomas involving the gastrointestinal, hepatic, or pulmonary systems. This condition may also be accompanied by high ­output cardiac failure during the initial proliferative growth phase, and these patients should be evaluated with ultrasound and/or CT/MRI imaging to rule out internal lesions.
A Rapidly Involuting Congential Hemangioma (RICH) is a type of vascular tumor that arises in utero, is present at birth, and then undergoes a rapid involution with near complete resolution of the tumor by 10­12 months of age. Often, however, the residual overlying skin results in significant atrophy and/or telangiectasias that may require further treatment.

 

A Non­Involuting Congential Hemangiomas (NICH) is a type of vascular tumor that also arises in utero, is present at birth, but does not undergo any involution, and persists into childhood and even adulthood. These types of vascular tumors cause significant disfigurement of the involved tissues, and often require treatment with a combination of sclerotherapy and surgery.
Kaposiform Hemangioendothelioma is associated with Kasselbach­ Merritt syndrome, a rare, life­ threatening condition characterized by a coagulopathy due to platelet trapping within the vascular tumor. These patients exhibit easy bruising and/or petechiae, and often require hospitalization for treatment with high­-dose steroids and blood product transfusions when necessary.

 

Other vascular tumors may include Tufted Angioma and Pyogenic Granuloma, and are often localized, small lesions that may be treated with either laser or local surgical excision.

Vascular Malformations

Port­-wine stains are a type of venular malformation where the veins in the involved skin gradually dilate and expand. This causes a pink or red stain to the involved skin, and over time if left untreated, these areas may gradually darken, thicken, and even develop nodular growths. In severe cases, the skin may become significantly hypertrophied, requiring surgery to remove the redundant tissue and restore normal contour and symmetry. Port­wine stains that involve the areas around the upper or lower eyelids should be evaluated by a vascular birthmark specialist and closely observed for possible association with Sturge­-Weber Syndrome, characterized by vascular malformation involvement of the eye and brain.

 

At the Vascular Birthmark Center, our philosophy is to provide prompt evaluation, confirm the diagnosis, and discuss appropriate treatment options to ensure that every patient has the opportunity to be treated in a timely and effective manner. For many children born with a port­-wine stain, early intervention with laser therapy is indicated in order to halt the natural progression (ie darkening and thickening) of the involved skin. For older patients, laser therapy can still be very effective in lightening the stain to a more comfortable level, even for those who have tried laser therapy in the past. For more advanced conditions, a combination of laser and/or surgery may be indicated to excise thickened tissue and restore normal contour and symmetry.
Also referred to as "cystic hygromas" or "lymphangiomas", lymphatic malformations are caused by abnormal dilatations or cysts of the lymphatic channels that normally return filtered lymph fluid back into the bloodstream. They are usually noticeable at birth as causing swelling of the involved tissues, and lymphatic malformations are classified as microcystic or macrocystic lesions. In microcystic disease, the lymphatic malformation occurs as multiple cysts within the skin and deeper tissues, leading to to swelling and enlargement of the involved structures. Along the surface structures, microcystic lesions may also form small, fluid-­filled sacs called vesicles. Macrocystic lesions typically involve just one or two large, fluid filled sacs that often cause significant enlargement of the surrounding soft tissues.

 

At the Vascular Birthmark Center, our philosophy is to provide prompt evaluation, confirm the diagnosis, and discuss appropriate treatment options to ensure that every patient has the opportunity to be treated in a timely and effective manner. Treatment of lymphatic malformations may involve medical, laser, or surgical therapy. Many lymphatic malformations swell significantly in response to local or systemic infections, and and may develop overlying erythema and warmth in response to local or systemic infections. In these cases, an oral course of steroids and antibiotics is often necessary to treat the underlying infection, however the swelling may remain for several weeks. A combination of surgical, laser, and sometimes sclerotherapy treatment is often necessary to attempt to control the progression of lymphatic malformations, remove the bulky disease, and restore normal contour and appearance to the involved tissues.
Arteriovenous malformations can involve the skin, muscle, or bone, and lead to significant enlargement of the involved tissues, and in some cases develop sudden and severe bleeding episodes with superficial lesions. Without treatment, these types of malformations continue to progress and may invade locally into surrounding tissues. Prompt diagnosis and management is necessary to try and maintain control and reverse these vascular changes.

 

Unlike a single abnormal connection as seen in arteriovenous fistula (AVF), arteriovenous malformations (AVMs) typically involve a nidus or central area with an absence of normal capillaries, instead involving multiple abnormal communications directly between arteries and veins. Arteriovenous malformations are always present at birth, but may not develop into noticeable lesions for several years or even into adulthood.

 

At the Vascular Birthmark Center, our philosophy is to provide prompt evaluation, confirm the diagnosis, and discuss appropriate treatment options to ensure that every patient has the opportunity to be treated in a timely and effective manner. Due to the aggressive nature of arteriovenous malformations, treatment often begins with serial embolization in order to control the progression of the lesion, with surgery reserved for removal of localized lesions, or to debulk larger lesions and restore normal contour and symmetry.

 

Venous Malformations are vascular malformation that develop from abnormal, dilated veins that lack the normal smooth muscle that normally line the walls can occur on any part of the body, and involve either the skin or mucous membranes of the mouth, tongue or airway. Venous malformations are sometimes misdiagnosed in children as deep hemangiomas. However, unlike hemangiomas that involute, venous malformations never involute, and grow progressively and proportionately with the patient over time. Venous malformations may be diagnosed by their characteristic enlargement on valsalva maneuver (inhaling a breath and holding it tight). They typically appear as blue or purplish lesions that easily compress on the skin or mucosa. In some families, a genetic component has been identified that is believed to cause the lack of muscle ­lining cells, leading to multiple cutaneous (skin) lesions.

 

At the Vascular Birthmark Center, our philosophy is to provide prompt evaluation, confirm the diagnosis, and discuss appropriate treatment options to ensure that every patient has the opportunity to be treated in a timely and effective manner. For most patients with venous malformations, early treatment through a combination of laser, surgery, and/or sclerotherapy is advocated to minimize the progressive enlargement and subsequent deformity that occurs with untreated venous malformations.
Midline Venular Malformations are sometimes referred to as "stork bites" or "angel kisses", midline venular malformations are another type of venular malformation that typically occurs along the midline structures of the face and neck. This also often appears along the hairline at the base of the neck, or as a "V" extending along the center of the forehead, but can also appear on the upper eyelids, nose and lips. This type of birthmark rarely requires treatment except for persistent stains that do not resolve by 18 to ­24 months of age.

 

Klippel­Trenaunay Syndrome (KTS) is a type of combined malformation that typically affects one of the upper or lower limbs, characterized by overlying skin involvement with port­-wine stains, and underlying Lymphatic Malformations of the soft tissues. In addition, there is asymmetric enlargement of the involved limb, often leading to limb lengthening and/or widening of the affected areas. Treatment is directed toward compression therapy of the involved limbs, and occasionally debulking surgery to restore normal contour and function of the involved tissues.

 

Angiokeratoma is a type of lymphatic malformation that involves primarily the surface skin and subcutaneous tissues of the chest, abdomen or extremities. These lesions are characterized by multiple superficial blebs that appear dark purple or black, and are prone to bleeding. The presentation is quite variable and treatment often requires a combination of aggressive laser therapy and occasional surgical excision of resistant or thickened tissues.

Additional Resources

Birthmark.org hosts the Web site for the Vascular Birthmarks Foundation (VBF). VBF hosts annual patient conferences, assists with insurance appeals, and helps network patients and families to leading experts from across the country. Founder and President Dr. Linda Rozell-Shannon has also worked closely with the American Academy of Pediatrics (AAP) helping to establish treatment guidelines for vascular birthmarks in newborn babies. Dr. Levitin volunteers as the Surgical Expert for the VBF and serves as a surgeon on their iTEAM medical missions. Access their Web site here.
Founded by Karla Hall, the National Organization for Vascular Anomalies (NOVA) advocates for patients and families with vascular anomalies with support groups, online forums, and annual Family Conferences. Nova News is the Web site for NOVA. Access their Web site here.
The Sturge-Weber Foundation (SWF) is the leading online resource for all medical issues relating to Port Wine stain related conditions. Founded by Karen and Kirk Ball, the SWF mission serves to support and educate patients, families, and communities through education, advocacy and research on Sturge Weber Syndrome and associated conditions. The SWF Web site is the most comprehensive resource support and services for individuals with Sturge-Weber syndrome and associated Port Wine Birthmark conditions. Access their Web site here.
Midline Venular Malformations are sometimes referred to as "stork bites" or "angel kisses", midline venular malformations are another type of venular malformation that typically occurs along the midline structures of the face and neck. This also often appears along the hairline at the base of the neck, or as a "V" extending along the center of the forehead, but can also appear on the upper eyelids, nose and lips. This type of birthmark rarely requires treatment except for persistent stains that do not resolve by 18 to ­24 months of age.

 

Klippel­Trenaunay Syndrome (KTS) is a type of combined malformation that typically affects one of the upper or lower limbs, characterized by overlying skin involvement with port­-wine stains, and underlying Lymphatic Malformations of the soft tissues. In addition, there is asymmetric enlargement of the involved limb, often leading to limb lengthening and/or widening of the affected areas. Treatment is directed toward compression therapy of the involved limbs, and occasionally debulking surgery to restore normal contour and function of the involved tissues.

 

Angiokeratoma is a type of lymphatic malformation that involves primarily the surface skin and subcutaneous tissues of the chest, abdomen or extremities. These lesions are characterized by multiple superficial blebs that appear dark purple or black, and are prone to bleeding. The presentation is quite variable and treatment often requires a combination of aggressive laser therapy and occasional surgical excision of resistant or thickened tissues.