BABY AND CHILDHOOD SKIN DISORDERS: BIRTHMARKS
'I want you to have a look at Melissa,' Pita said, as she brought her eight-week-old daughter into my surgery. 'She is developing a lump on her side, and it is worrying me.'
Pita was a good mother, having already reared two older infants, and now this was her third, a girl (at long last!).
A few moments later I was checking Melissa's lithe little body— babies have such lovely soft cuddly skin. I've been checking them for nearly three decades and I am still impressedat how lovely their skin usually is.
'See, there it is,' Pita said, indicating a small bright red spot about a centimetre wide on Melissa's trunk. 'It started to appear about a fortnight ago, and is quickly getting bigger. I'm scared stiff it's a birthmark, although it was certainly not there when she was born. I'm also wondering if it could be a cancer.'
I checked Melissa for this, and the possibility of other lesions.
'I can assure you this is not a cancer, Pita,' I said. 'Melissa has a birthmark. It belongs to a family of strange skin complaints that are very common in children. They are often referred to as vascular naevi, and this particular fellow has the unwieldy name of capilliary haemangioma, or simply "strawberry mark". It looks a bit like a tiny strawberry, doesn't it?'
'It does, now you've mentioned it,'Pita said. 'But what do we do? Do you cut it off, or do we put something on it?'
'I've got good news for you. We don't do anything at all.'
'What, just let it get bigger and bigger?' Pita asked, raising her voice in disbelief.
'Yes. We do nothing,' I replied, keeping my cool. I have had this experience many times and I was quite sure of my facts. 'It may seem amazing to you, but even though it might increase considerably in size—and, what's more, several others may also put in appearance—in due course all will vanish. Completely fade from sight. No treatment whatsoever is required. Over the next few months, it will inevitably increase in size, but then it will tend to start to shrink. It may take quite a long time for it to regress (as we doctors say) and become smaller. But this usually happens.
'In some very severe cases, it can take up to eight or ten years. But during childhood, this doesn't matter too much and doesn't interfere with life. Cosmetically, it is during adolescence that we are more worried about, plus in later life.
'Occasionally these may sometimes bleed if they are knocked, but gentle pressure for a short time usually checks the bleeding, and it is seldom severe or dangerous. On rare occasions, if this continues to happen the skin specialist may decide to remove them. Perhaps by freezing them away using frozen carbon dioxide, various forms of X-ray or even surgery. But, as I said, the majority simply vanish.'
'I am relieved to hear it,' Pita said. 'Now I won't worry nearly so much. But tell me, some babies seem to be born with rather unattractive purplish marks on their body, even on the face or scalp. Are they the same?'
Those are commonly called "port wine stains". They also have technical names such as macular haemangioma, or flame naevus, but let's stick to simple terms; they are easier to remember. It is a smooth, flat haemangioma and the colour varies from red to dark purple. They are most common on the face or neck, and the size may vary from a few millimetres to a very extensive area which may almost completely cover the face, neck or upper part of the chest. The range is enormous. Often a very small area will occur on an eyelid or nose.'
Treatment
'How are they treated?' Pita asked.
'Small ones are best left alone. Often as the baby gets older, little areas will tend to fade, and many entirely vanish in due course. But large discoloured sheets simply refuse to budge, whatever form of treatment is tried. So, instead of interfering, as the child becomes older and particularly in adolescent and adult life later on, efforts are made to camouflage the pigmented areas. Many camouflages are available, ranging from cosmetic masking applications, to tattooing—the latter is a recent idea. In due course, I feel sure that a treatment will be found to fix these unsightly stains when they cause embarrassment. But they are not cancerous and will not develop into cancers either.
'The biggest problem is trying to convince people that there is no satisfactory treatment, and getting them to ignore pressures from well-meaning friends or relatives who insist that "something be done".'
'Just the same, most parents would like something to be done if possible,' Pita said. 'Still, I suppose if action might make it worse, it is best left alone.'
'There is another kind that is worth mentioning while we are talking about these skin problems,' I continued. 'These are called cavernous, or mature, haemangiomas. They are skin lumps caused by large blood-containing spaces just under the skin. They are raised up, have an ill-defined border, and in principle are similar to the strawberry marks. If you press the middle of a lump, it will turn white. In due course, these also often gradually become smaller, and many of them finally disappear.
'However, some may bleed severely if knocked or bumped and may pose a problem for this reason. Sometimes the skin specialists decide to treat them with X-ray therapy or by injecting material that causes them to shrink. Some are even surgically removed. But, as I said, most will become smaller and many disappear in due course.'
'That's nice to know,' Pita said. 'At least, my mind is now at rest. I won't worry about Melissa so much now—irrespective of what all my relatives have to say. Thanks for the advice!'
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General Health
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