A birthmark is an irregularity on the skin which is present at birth or appears within the first few months. They are divided into two main types: pigmented and vascular. Pigmented birthmarks are caused by excess pigment cells and are dark in color. Vascular birthmarks are caused by increased or malformed blood vessels and are red or purple in color. They can occur anywhere on the skin. Birthmarks are almost always painless and benign but can be worrisome and cosmetically bothersome to parents.
These marks are flat and light pink or red, similar to the color of salmon, which is where they get their name. They are sometimes located on the forehead or cheeks and will become darker with crying or any other activity that might cause the blood vessels to dilate. If they are found on the nape of the neck, they are also referred to as “stork bites”, referring to the area that they would have been carried when delivered by the stork. Darker colored patches can occasionally be treated with vascular lasers, but often no treatment is required.
A strawberry hemangioma is bright red and protrudes from the surface of the skin. These are often present right at birth. Deep hemangiomas have a dark blue-purple appearance and develop shortly after a baby is born. The deep hemangioma makes the skin swell and bulge and can continue to grow over the first year. Although these can be very concerning to parents, the good news is the majority start to regress spontaneously after the first year. Most hemangiomas become completely flat between the ages of 7 and 10. Treatment is only required if the birthmark becomes irritated or bleeds.
Port Wine Stain
A port wine stain is usually a large flat patch of purple or dark red skin with well-defined borders that is present right at birth. Overtime, the skin can become darker and develop a bumpy surface. Generally, they appear on one side of the body, with the majority of them occurring on the face. Unlike infantile hemangiomas, port wine stains will NOT regress and fade spontaneously. Conversely, they can become darker or develop vascular blebs (bumps) over time. Therefore, early treatment is recommended. A non-ablative vascular laser can constrict the blood vessels fading them dramatically and preventing the thickening that can occur with age.
A congenital melanocytic nevus is a pigmented birthmark caused by a proliferation of melanocytes (pigment producing cells) that are present at birth or develop shortly after birth.Congenital melanocytic nevi are usually classified by size:
- Small congenital melanocytic nevi are < 1.5 cm in diameter
- Medium congenital melanocytic nevi are 1.5–20 cm
- Large or giant congenital nevi are >20cm in diameter
The risk of melanoma is related to the size of the congenital melanocytic nevus. Small and medium sized congenital melanocytic nevi have a small risk of developing into melanoma, only marginally higher than a regular acquired mole. Melanoma is more likely to develop in giant congenital nevi (lifetime estimates of developing into melanoma is approximately 5-10%), particularly in lesions that lie across the spine or where there are multiple satellite lesions. It is normal for the birthmark to grown gradually in proportion to your child’s normal growth. However, any dramatic increase in size, shape or colour should be assessed by a Dermatologist. Regardless of the size, it is recommended that you measure and monitor it closely for atypical changes. We recommend that you refer to the ABCDE chart used for melanoma diagnosis.
Over time, these birthmarks may start to grow dark terminal hairs. These hairs can be left in place or trimmed to improve the cosmetic appearance. Contrary to popular belief, cutting or shaving the hair will not cause it to grow darker or thicker.
As these birthmarks can be cosmetically disfiguring, many parents are anxious to consider treatments for removal. Unfortunately, there is not an easy way to remove these types of birthmarks. Removing a congenital pigmented nevus requires cutting out the nevus with a surgical blade, and stitching the removal site closed. Regardless of the technique, this cannot be done without leaving a surgical scar. For small and medium sized congenital nevi, surgical excision may be considered. However, in large and giant sized nevi surgical is complex, often requiring tissue expanders and the expertise of a plastic surgeon.
Although there has been tremendous advancement in laser technology, there are still no effective methods to remove or even lighten these birthmarks with laser. Even if the laser destroys the majority of the pigmented cells, the pigmentation almost always recurs as it lies in the very deep layers of the skin. As a result, observation is often the best option for most pigmented birthmarks. Although, physician evaluation is required in the event of any suspicious changes.
Cafe-au-lait is French for “coffee with milk,” which describes the color of these spots. They are light brown when found on light skin and the color of black coffee when located on dark skin. They are often oval-shaped and can range dramatically in size. They are harmless and very difficult to treat. Some areas may fade spontaneously over time, but treatment is rarely recommended.
These types of spots have a grey-blue color and are most often located on the backs or bottoms of dark-skinned babies. They can look like bruises, but like most birthmarks, are not painful. These are also difficult to treat, and are most often left alone.
Nevus of Ota
What is Nevus of Ota?
Nevus of Ota is birthmark that appears as a blue/black or grey patch that lies along the path of the ophthalmic and the trigeminal nerves. For this reason, most seem to be located on the forehead, periorbital and cheek region. It more common in Asians or darker skin types, and is found in women four times more frequently than men. This is an unusual birthmark where it can have an onset in infancy or may not appear until adolescence.
Nevus of Ota Treatment
The QX MAX ND Yag 1064nm laser has revolutionized the treatment of these birthmarks by selectively targeting the excess pigment in the skin without damaging the surrounding area or affecting normal skin tone. As these birthmarks tend to lie quite deep in the skin, it requires a long wavelength to target the appropriate excess pigmentation. This is a non-ablative (does not cut the surface of the skin) laser that “shatters” the pigment into tiny particles that can then be removed through the body’s natural excretion processes.
When treating the eyelid region, internal metal contact lens eye shield will need to be inserted. A numbing eye drop is placed into the eye prior to insertion, which makes it painless. As the laser targets the deep pigmentation, a snapping or prickly sensation may be felt. A topical numbing cream can be prescribed that can be applied 60-90 minutes prior to the treatment. Local anesthetic may be used when treating around the eyes to make the procedure easier to tolerate.
Immediately following the treatment, there will be some small areas of pinpoint bleeding, swelling and/or bruising. Although this can be quite alarming, it heals relatively quickly with no scarring. It is important to keep the skin well hydrated while healing.
The number of treatments required varies significantly between patients, but a minimum of four to eight treatments can be expected. Treatments should be spaced a minimum of three months apart to allow your body to remove as much of the excess pigment as possible before proceeding with next treatment. Our goal is not to completely eliminate the birthmark, but to fade it by 50-75% making it much less noticeable. As this type of pigmentation lies in the very deep layers of the skin, maintenance treatments may be required every few years if some of the pigment recurs.