Birthmark Removal And Treatment Options
Birthmarks come in a variety of shapes and sizes. As the name suggests, they can be present at birth, but may develop later on in infancy. Birthmarks can arise from multiple structures of the skin, even hair follicles and muscle. One broad way of classifying them is to group them into birthmarks arising from pigment cells and those from the vascular system.
Pigmented birthmarks, also known as congenital melanocytic nevi, are typically present at birth. They arise from melanocytes, which produce pigment in the skin. They are often brown and flat at birth, but can become darker, raised, and grow hair as we age. As we grow, our birthmarks typically grow proportionately in size. Up to 30% of the population has a pigmented birthmark, typically under 1.5 inches in diameter. The risk of melanoma developing in birthmarks of this size is low, equivalent to the general lifetime risk of malignant melanoma is the US of about 2%.1 One exception is the giant congenital melanocytic nevi, which are birthmarks larger than 20 centimeters (or 8 inches) in size, which have a slightly higher risk of melanoma development in childhood.
A variety of other pigmented birthmarks exist beyond congenital nevi. These include Mongolian spots and café-au-lait patches. Mongolian spots are blue-gray patches typically on the lower back that fade over time. Café-au-lait patches are the color of “coffee with cream.” While solitary patches are common, it is important to note that multiple spots can be associated with an underlying genetic diagnosis.
As the majority of pigmented birthmarks are benign, birthmark removal is not always necessary. Monitor your birthmark regularly for changes in size or shape. As birthmarks can occur in cosmetically sensitive areas, a variety of treatment options exist to lessen their appearance. Surgical removal by a dermatologist or plastic surgeon may be necessary for permanent treatment of unwanted nevi.
Another broad category of birthmarks is those arising from blood vessels. The most common type is known as an infantile hemangioma, which typically appears at birth or shortly thereafter as a small strawberry-shaped bump. Up to 10% of infants may develop an infantile hemangioma.2 These birthmarks typically grow quickly in size during the first six months of life, after which time they typically stop growing and begin to shrink.
Over time most infantile hemangiomas will disappear on their own, however there are instances where treatment is recommended. For example, if one occurs around the eye, it can obstruct and prevent normal visual development if left untreated. Occasionally large facial infantile hemangiomas are associated with underlying genetic disorders, which require a team of specialists for management and treatment. A variety of treatment options exist, including both topical and oral medications. Early intervention is recommended, as some birthmarks may leave behind a scar or saggy skin after they disappear.
Another common vascular birthmark that may require treatment is a port-wine stain. Named because of their dark red or purple color, they occur when blood vessels form abnormally. Port-wine stains will slowly darken and thicken over time. Unlike infantile hemangiomas, they do not resolve on their own and often do not respond to medications. Laser treatments both in childhood and later in life can help improve the color and appearance of vascular malformations like port-wine stains as well as improve the appearance of scars left by large infantile hemangiomas.
Birthmark removal is a personal decision, which should be made after considering all options. A conversation with your dermatologist regarding large, changing, or cosmetically concerning birthmarks will help to decide what treatment is right for you.
1In Howlader N., Noone A.M., Krapcho M., Neyman N., Aminou R., and Waldron W. (eds): SEER cancer statistics review, 1975-2008. Bethesda (MD): National Cancer Institute, 2011.