Birthmark

Any mark, spot, or bump that is present in or around the time of birth on the skin of an infant is a birthmark. Mothers are fond of giving these rather romantic names such as angel's kisses, stork bites, or beauty marks. Most of these lesions are not particularly esthetically desirable.

Birthmarks can be categorized according to their composition. Marks as a result of excessive accumulation of melanin are called pigmented birthmarks since the great majority of them are brown to black. Other birthmarks appear lighter than the rest of the skin due to a relative lack of melanin.

Some birthmarks are composed of blood vessels and are called vascular birthmarks. They are generally red, blue, or purple. Other birthmarks are composed of lymphatic tissue (cystic hygroma), breast tissue, and epidermal tissue, which are often yellow to flesh-colored.

Pigmented birthmarks can be flat or elevated. They may simply be due to excessive deposition of melanin pigment in the deeper layers of the skin called dermal melanosis. This is particularly common in more heavily pigmented infants and is commonly called a Mongolian birthmark or spot. More frequently, there are accumulations of melanin produced by and contained in pigment cells called melanocytes. The medical term for such a concentration of melanin-producing cells is a nevus. These nevi are generally small, no larger than ¼ inch in diameter, however, they can be quite large, covering a significant portion of the infant's skin.

The color of vascular birthmarks ranges from light pink to dark purple, and they can be either flat or elevated. Their size is quite variable, as well. Certain types of vascular birthmarks can evolve and change after birth.

A hemangioma is a type of vascular birthmark that is also called a strawberry mark, nevus vascularis, capillary hemangioma, or hemangioma simplex. A strawberry birthmark can appear on any part of the body. The most common areas of the body where you will find a hemangioma include the face, scalp, back, or chest.

The red color of the strawberry birthmark comes from the closely packed blood vessels where it is found. It is painless and the actual cause is not known. 

A strawberry mark will typically appear at birth and may grow quickly. Oftentimes it will disappear from the child's skin by age 9.

Most birthmarks are probably due to defective migration of cells during fetal development. Once these cells start to multiply, they produce tissue with the characteristics of their cell type though they are not where those cells typically are located.

Several rare serious disorders are associated with both pigmented (café au lait mark, for example) and vascular birthmarks. It would be appropriate that any infant with a birthmark is examined by a pediatrician to detect any of these uncommon conditions. Some of these disorders can be inherited, so affected families need to be educated as to their significance.

It is possible for birth trauma to produce sufficient damage to leave a scar. This scarring could be interpreted as a birthmark.

Pigmented birthmarks, aside from their coloration, cause no symptoms. Vascular birthmarks of certain types can produce significant symptoms. The identification of the type of vascular birthmarks may be difficult and require certain advanced imaging techniques as well pathological examination of samples of the birthmark. Certain vascular birthmarks called hemangiomas can begin as flat lesions at birth but enlarge rapidly during the first few months of life. They may ulcerate and disappear slowly, leaving only a scar. If this type of lesion is situated adjacent to an important anatomical structure like an eye or mouth, it may need to be treated to hasten the natural resolution.

It is now possible to treat many kinds of both pigmented and vascular birthmarks. The approach depends on the type of tissue involved and the risks versus the benefits of treatment. The pediatrician is an excellent source of information as to potential treatment options.

Birthmark removal depends on the nature of the tissue involved. Medical treatment can hasten the resolution of certain kinds of vascular birthmarks. Generally, measures that destroy the involved cells of the birthmark are required for both pigmented and vascular birthmarks. Either scalpel surgery, lasers, and rarely radiation can be helpful.

As with all such questions about insurance coverage, each company may be different. Most birthmarks that are small and not visually unpleasant are unlikely to require treatment and are rarely covered. Any birthmark that is likely to impair either the physical or mental health of the child is much more likely to be covered.

A few small pigmented birthmarks are quite common and do not need to be treated. This is also true for vascular birthmarks. Smaller hemangiomas will disappear spontaneously, leaving a small insignificant scar depending on the sites involved. Dermal melanosis eventually fades.