Birthmarks Health Article

Definition

Birthmarks, including angiomas and vascular malformations, are benign (noncancerous) skin growths composed of rapidly growing or poorly formed blood vessels or lymph vessels. Found at birth (congenital) or developing later in life (acquired) anywhere on the body, they range from faint spots to dark swellings covering wide areas.

Description

Skin angiomas, also called vascular (pertaining to vessel) nevi (marks), are composed of blood vessels (hemangiomas) or lymph vessels (lymphangiomas), that lie beneath the skin's surface. Hemangiomas, composed of clusters of cells that line the capillaries, the body's smallest blood vessels, are found on the face and neck (60%), trunk (25%), or the arms and legs (15%). Congenital hemangiomas, 90% of which appear at birth or within the first month of life, grow quickly, and disappear over time. They are found in 1-10% of full-term infants, and 25% of premature infants. About 65% are capillary hemangiomas (strawberry marks), 15% are cavernous (deep) hemangiomas, and the rest are mixtures. Hemangiomas are three times more common in girls. Usually, only one hemangioma is found, in 20% two are found, while fewer than 5% have three or more. Lymphangiomas are skin bumps caused by enlarged lymph vessels anywhere on the body.

Vascular malformations are poorly formed blood or lymph vessels that appear at birth or later in life. One type, the salmon patch (nevus simplex), a pink mark composed of dilated capillaries, is found on the back of the neck (also called a stork bite) in 40% of newborns, and on the forehead and eyelids (also called an angel's kiss) in 20%. Stork bites are found in 70% of white and 60% of black newborns.

Found in fewer than 1% of newborns, port-wine stains (nevus flammeus), are vascular malformations composed of dilated capillaries in the upper and lower layers of the skin of the face, neck, arms, and legs. Often permanent, these flat pink to red marks develop into dark purple bumpy areas in later life; 85% appear on only one side of the body.

Acquired hemangiomas include spider angiomas (nevus araneus), commonly known as spider veins, and cherry angiomas (senile angiomas or Campbell de Morgan spots). Found around the eyes, cheekbones, arms, and legs, spider angiomas are red marks formed from dilated blood vessels. They occur during pregnancy in 70% of white women and 10% of black women, in alcoholics and liver disease patients, and in 50% of children. Cherry angiomas, dilated capillaries found mainly on the trunk, appear in the 30s, and multiply with aging.

Causes and symptoms

There are no known causes for congenital skin angiomas; they may be related to an inherited weakness of vessel walls. Exposure to estrogen causes spider angiomas in pregnant women or those taking oral contraceptives. Spider angiomas tend to run in families, and may be associated with liver disease, sun exposure, and trauma.

Hemangiomas

Hemangiomas first appear as single or multiple, white or pale pink marks, ranging from 2-20 cm (average 2-5 cm) in size. Some are symptomless while others cause pain or bleeding, or interfere with normal functioning when they are numerous, enlarged, infected, or ulcerated. Vision is affected by large marks on the eyelids. Spider and cherry angiomas are unsightly but symptomless.

Each type of hemangioma has a characteristic appearance:

• Capillary hemangiomas (strawberry marks). These round, raised marks are bright red and bumpy like a strawberry, and become white or gray when fading.
• Cavernous hemangiomas. These slightly raised, dome-shaped, blue or purple swellings are sometimes associated with lymphangiomas or involve the soft tissues, bone, or digestive tract.
• Spider angiomas. These are symptomless, reddish blue marks formed from blood-filled capillaries radiating around a central arteriole (small artery) in the shape of a spider web.
• Cherry angiomas. These harmless, dilated capillaries appear as tiny, bright red-to-violet colored bumps.
• Lymphangiomas. These dilated lymph vessels form light pink or yellow cysts (fluid-filled sacs) or swellings.

Vascular malformations

These are faint, flat, pink stains that grow as the child grows into larger dark red or purple marks. Some are symptomless but others bleed if enlarged or injured. Disfiguring port-wine stains can cause emotional and social problems. About 5% of port-wine stains on the forehead and eyelids increase eye pressure due to involvement of the eye and surrounding nerves. Abnormalities of the spinal cord, soft tissues, or bone may be associated with severe port-wine stains.

Each type has a characteristic appearance:

• Salmon patches. These symptomless, light red-to-pink marks usually fade with time.
• Port-wine stains. These flat, pink marks progress to raised, dark red-to-purple grape-like lumps distorting the facial features, arms, or legs.