A birthmark is a discoloration on or under the skin that is either present from birth or develops shortly thereafter. Birthmarks can often be small, like a more traditional “beauty mark”, and many fade over time, but others can become more pronounced. Unsightly marks can be difficult for self-confidence or, in some cases, suggest underlying medical conditions. If you are worried about a birthmark or are seeking birthmark removal, board-certified dermatologist Dr. Green is here to help.
What are the different types of birthmarks?
There are many different types of birthmarks and they are defined by two major categories: vascular birthmarks and pigmented birthmarks.
Vascular birthmarks are made up of an unusual development of blood vessels, which can form clusters or become wider than they should be. Vascular birthmarks are not related to anything that the mother does or does not do during pregnancy. This birthmark can range in color from a pinkish hue to dark purple. This type of birthmark ranges from elevated to flat, and also varies in size. Most vascular birthmarks can change over time as the infant grows. There are several types of vascular birthmarks which include:
The term Port-wine stain is inspired by its often dark, purplish color, though the initial birthmark generally has a lighter pink or red hue. Port-wine stains develop from abnormal growth of small blood cells, typically presenting on the skin of the face and neck.
These small blood vessels naturally receive a certain chemical signal, but when the signal continues longer than normal, the vessels increase in size. This abnormal development is due to one specific gene, but the cause of this gene mutation is unclear. In rare cases, this gene mutation can lead to Sturge-Weber syndrome, which targets the brain, but this is only found in 3% of infants with facial port-wine stains. Port-wine stains are occasionally linked with other medical concerns, particularly if they appear on the eyelids, so this type of birthmark should be monitored by your health care provider.
This type of birthmark can develop a darker pigmentation, as well as a pebbled texture, if left untreated. The birthmark typically lasts into adulthood, and generally grows as the child grows. Port-wine stains don’t typically cause any discomfort or itchiness, though they can sometimes have a drier skin texture than the surrounding area. However, if a port-wine stain begins to hurt or bleed, you should contact your health care provider.
In general, port-wine stains are harmless birthmarks, but if the mark covers a large area of the body or is located on the face, it can affect a child’s self-esteem. If you’re concerned about the appearance of a port-wine stain, Dr. Green is more than happy to discuss treatment options. She frequently treats port-wine stains with the Vbeam laser treatment. The Vbeam is the gold standard for treating vascular lesions, such as port-wine stains. Several sessions are required but the results will improve these cosmetic lesions significantly.
Salmon patches are pink or red patches caused by a cluster of blood vessels. Also referred to as stork bites or angel kisses, these common birthmarks are typically found on the eye area and on the back of the neck. Salmon patches often fade over time, and require no medical treatment.
Salmon patches are caused by temporary dilations (expanding movement) within smaller blood vessels. This type of birthmark is incredibly common: 7 out of 10 babies are born with a salmon patch or two. If this kind of birthmark is found on the face, it will typically disappear within the first couple of years of the child’s life, whereas a salmon patch on the back of the head or neck will remain. Unlike port-wine stains, salmon patches do not grow with the child, and do not darken in color over time. They are generally harmless and considered noncancerous.
Hemangiomas are bright red, pink or bluish birthmarks that are often found on the extremities, as well as the head and neck. Also referred to as strawberry or cherry hemangiomas, this type of birthmark is a cluster of blood cells on the baby’s skin. These birthmarks can appear small and flat at birth, and many hemangiomas fade over early adolescence, leaving behind a faint mark. However, as they can grow and become elevated over time, varying in size and shape, hemangiomas should be monitored by a healthcare professional.
If the birthmark is developing rapidly, it may require medical removal in order to prevent the infant from experiencing difficulty breathing or vision impairment. If multiple hemangiomas are found, it may suggest internal hemangiomas, which should generally be removed. Furthermore, hemangiomas can be a sign of Klippel-Trenaunay syndrome, which is a rare congenital malformation that affects the development of the lymph and blood systems, as well as soft tissues and bones. Continued discussion of any large hemangioma growth with your doctor will ensure that any underlying conditions are treated in a safe and timely manner.
Pigmented birthmarks are the result of either overproduction or lack of melanin. These birthmarks generally range from pink all the way to black in color. In some cases, pigmented birthmarks are lesions that have damaged pigment cells, creating lighter skin than the overall rest of the body. Pigmented birthmarks can be elevated or flat. Common types of pigmented birthmarks include:
Café au lait spot
Café au lait spots are inspired by the French phrase “coffee with milk,” as they are identified as a flat, ovular mark with light brown pigmentation. This birthmark can develop through early childhood, and can turn darker in color with excess sun exposure. Café au lait spots are equally likely to become larger in size or to fade over time; they tend to vary from 0.5 centimeters in size up to 20 centimeters in diameter.
Café au lait spots are generally risk-free, and infants or young children can present with one, two or three spots without risk. However, if a child below age five presents with more than five of this type of birthmark, it may suggest a rare medical condition called Neurofibromatosis. This medical condition causes tumors in the brain and spine, and is often associated with colored patches on the skin and lumps under the skin, as well as speech problems. Multiple café au lait spots should be closely observed by a medical professional, in case any complications should arise.
Congenital nevi (moles)
Congenital nevi, or moles, are circular birthmarks that vary in size and range in color, from pink to brown to black. Also known as a congenital melanocytes nevus, this birthmark can be elevated or flat, and can appear anywhere on the body.
A congenital nevus is created when pigment-producing skin cells (melanocytes) cluster together, creating a darker area. A mole can alter in size throughout one’s life, and sometimes, it can become raised, bumpy, or have hair growing out of it. Occasionally, a mole will disappear completely, though this is uncommon. Congenital nevi are further classified under the following terms:
- small nevus: less than 1.5cm in diameter
- medium nevus: 1.5-19.9cm in diameter
- large nevus: 5cm or larger in diameter on a newborn
- giant nevus: covering a large area on the body, accompanied by smaller nevi nearby
- garment nevus: located near the child’s bottom, or on the full arm/shoulder
- satellite nevi: smaller moles (like those surrounding a giant nevus)
- speckled lentiginous nevus: a mole with a tan base, speckled with darker patched on top
- halo nevus: mole with light-colored skin cells along the outside edge
Though moles generally don’t cause any physical problems, any change in mole shape or size later in life could suggest skin cancer, so it’s important to track any mole changes with your dermatologist. If an infant is born with a large or giant nevus, regular skin exams are highly recommended, as complications related to the brain and spinal chord can occur. Furthermore, if you are dealing with an unsightly mole that is affecting self-esteem or causing discomfort, you can talk with your dermatologist about removal treatment options.
Congenital dermal melanocytosis, commonly referred to as Mongolian spots, are flat, bluish-gray spots that typically appear on the lower back and bottom. They are commonly found in infants with darker skin tone, and are usually present at birth, though they can develop shortly thereafter. This type of birthmark occurs when pigment is somehow stymied in the deeper layers of the dermis while the infant is developing.
The term Mongolian spots came into use by a German professor in 1885, who believed that Mongolian and non-Caucasian people were the only people with this specific type of birthmark. Mongolian spots can appear on any infant, but are more commonly found in African, Asian, Hispanic, Native American, or East Indian children. This type of mark has had religious symbolism in the past, with some interpreting it as a “spank” from a religious deity.
Though the pigmentation of these spots can sometimes look like bruising, this birthmark is not harmful or painful in any way. In a minimal number of cases, Mongolian spots have been linked to rare metabolic diseases, including Hurler’s disease, Hunter’s syndrome, and Niemann-Pick disease, but the link to these diseases, in addition to spinal cord malformation, is ongoing.
The majority of Mongolian spots are painless, pose little to no health risk, and often fade over time. However, they can be cosmetically problematic when they occur on the face or neck. Treatment options for Mongolian spots consist primarily of the Alex-Trivantage laser. Dr. Green is an expert in removing Mongolian spots. and the laser treatment consists of multiple sessions spaced approximately two months apart, to reduce the appearance of these lesions.
Birthmark Removal Treatment
Is it possible to remove birthmarks?
Birthmarks are, in fact, safe and easy to remove, typically through the use of laser therapy. Typically, birthmark removal is recommended in the case of fast-growing vascular birthmarks as early as possible, as birthmark removal is most effective in early development of the mark. However, if a birthmark becomes unsightly and begins to affect a patient’s self-esteem, removal treatment can be done for cosmetic reasons at any age.
There are several different birthmark removal approaches, depending on the type of birthmark. Treatments include:
- laser therapy: This is the most common form of treatment, particularly for port-wine stains or other large birthmarks.
- surgical excision: This is used particularly for moles, and the birthmark is removed from the skin using surgical tools.
- light therapy. This birthmark removal treatment is sometimes used for flat birthmarks, and is also commonly used for acne, scars, age spots and freckles.
- beta-blockers, such as propranolol. Beta-blockers are occasionally used to shrink the blood vessels of a hemangioma, thereby softening, fading, and shrinking the hemangioma. This can be taken orally or applied topically
Birthmark Removal FAQs
Does birthmark removal hurt?
Depending on the birthmark removal process, treatment can cause some discomfort, particularly for young children. However, during treatment, patients can typically be given local anesthesia, and will require very little downtime, with a recovery period for the affected skin that lasts about one week.
How does laser birthmark removal work?
Thanks to advancements in laser technology within the dermatology community, laser therapy is now a go-to approach for both vascular and pigmented birthmark removal. During treatment, a pulsed dye laser is able to break down clusters of pigment cells into fragments that are small enough to be removed naturally by the body’s own immune system. Laser birthmark removal usually requires several sessions, and will permanently remove the birthmark.
Does laser birthmark removal hurt?
Laser birthmark removal no more uncomfortable than the majority of birthmark treatments, and typically a patient will be given local anesthesia. With some very young patients, general anesthesia may be given to help them stay relaxed or sleep during treatment. After the procedure, the skin may appear swollen or bruised, but this is not usually accompanied with any pain. The treated area will typically return to normalcy within 7 to 10 days.
How much does birthmark removal cost?
A common concern from patients is in regard to cost: How much is birthmark removal surgery? How much is laser birthmark removal? Does insurance cover birthmark removal?
Depending on the treatment, birthmark removal cost can vary. Your insurance may not cover cosmetic birthmark removal but, if a birthmark is removed due to medical risk, we can likely work with your insurer in regards to your treatment plan. Our office is dedicated to helping you find the treatment that fits your needs, and affordable options are available.