Are there good and bad birthmarks? If you have one like this, it may turn into a malignant one, so be careful!

Expert of this article: Yang Shi, Associate Researcher, Center for Comparative Medicine, Peking Union Medical College

Many babies are born with bright red or purple "marks".

Different mothers have different opinions on these birthmarks. Some think that they affect the appearance and try to remove them; others think that birthmarks will gradually disappear with age and it doesn’t matter as long as they are not on the face.

But in fact, birthmarks can be good or bad. Some birthmarks not only affect the appearance, but even have the potential to become malignant.

For example, some birthmarks are hemangiomas, which are the most common benign vascular tumors in infants and young children. The incidence rate is as high as 4~5%, and there is an increasing trend year by year.

Although most hemangiomas are benign tumors, a small number are not so "quiet" and severe cases can even be life-threatening.

1

Which hemangiomas are "good" and which are "bad"?

Hemangioma is a congenital disease that originates from the mesoderm. It is a benign tumor caused by congenital vascular endothelial cell proliferation, intradermal capillary proliferation and dilation, and vascular malformation.

Infantile hemangiomas usually occur at birth or soon after birth. Infantile hemangiomas refer specifically to hemangiomas in infancy. They increase in size with age and generally stop developing in adulthood.

Which hemangiomas require attention and which ones will not cause harm?

Benign tumors that do not require excessive attention:

Port-wine stain: It often occurs at birth or shortly after birth, and is more common on the occipital region and face. It is usually unilateral, occasionally bilateral, and generally does not exceed the midline.

The lesions are one or several bright red or purple spots of varying sizes and shapes, not raised, with clear edges. They occur on the face and may spread to the oral mucosa. A few lesions have nodules or wart-like protrusions. They grow fast in infancy and develop slowly afterwards. They stop expanding after reaching a certain size. Those located on the occipital area, forehead, and nose often disappear on their own. Large or extensive ones may persist for life.

"Bad" hemangiomas to watch out for:

Simple hemangioma: also known as capillary hemangioma or strawberry tumor, often appears at birth or 3-5 weeks after birth, more common in female babies.

It manifests as one or several red spots or small erythema on the skin, which grows rapidly and expands to several centimeters or larger within a few months. It has clear boundaries and may fade slightly when pressed, but return to red after release. Most are hamartomas, which grow to their maximum size within 1 year and stop growing or disappear. They may disappear completely or incompletely within a few years, and a few may be complicated by cavernous hemangiomas. If the growth rate is faster than that of an infant, it is a true tumor.

Cavernous hemangioma: Generally composed of small veins and fatty tissue.

It often occurs at birth or shortly after birth, and is prone to occurring on the scalp and face. It is red, purple-red or dark purple in color, the size of a finger or an egg, soft like a sponge to the touch, shrinks when pressed, and recovers when pressure is removed. When it increases in size, it may rupture or become infected.

Subcutaneous cavernous hemangioma has a soft texture and unclear boundaries. Some are slightly compressible and may have calcified nodules and may be tender.

Intramuscular cavernous hemangioma often causes muscle hypertrophy and local sagging. If it occurs in the lower limbs, there will be a feeling of swelling when standing for a long time or walking more. When it occurs in infants, it may be accompanied by thrombocytopenia and purpura. It is a consumptive coagulopathy.

Racemose hemangioma: It is composed of thicker tortuous blood vessels, most of which are veins, but there may also be arteries or arteriovenous fistulas.

In addition to occurring under the skin and in the muscle, it often invades bone tissue, with a large range, even exceeding one limb. Hemangiomas often have winding blood vessels with obvious compressibility and expansion. Some can hear vascular murmurs, and some can touch induration, which is caused by thrombosis and perivascular inflammation. The skin of the lower limbs may become thinner, colored, or even ulcerated and bleeding due to nutritional disorders, affecting the ability to exercise. In adolescents, the limbs grow and thicken.

2

Can I just ignore a hemangioma after discovering it?

Hemangiomas are generally benign tumors that usually stop developing in adulthood.

However, if the hemangioma involves special parts, damages organ function or is accompanied by developmental abnormalities, is large in number, covers a large area, grows too fast, ruptures and bleeds or causes secondary infection during growth, it can lead to complications, disfigurement and other physical and mental illnesses, and may even develop into a true tumor. It is very dangerous and requires active treatment. Allowing it to develop will lead to serious consequences.

In addition, hemangioma is a congenital disease, and congenital diseases are not hereditary diseases. There is no conclusive scientific evidence that hemangioma is directly related to heredity.

3

Is surgery the only way to treat hemangioma?

Treatment principles:

It depends on the individual. Individual differences are large and situations vary. It is not easy to generalize. Please follow the doctor's advice and choose under the guidance of the doctor. 12-word principle: respect the doctor, actively communicate, and avoid minefields.

It depends on the individual. Neither ignore nor over-treat. Sometimes multidisciplinary consultations with dermatologists, pediatricians, and surgeons are needed to develop the best treatment plan.

Port-wine stains: Carbon dioxide laser and freezing have certain therapeutic effects.

Simple hemangioma: In the early stage, when the tumor is small, it can be treated with carbon dioxide laser or liquid nitrogen freezing. When the tumor grows, it can still be treated with liquid nitrogen freezing or surgical removal, but it is easy to leave scars. 32P dressing or shallow X-ray irradiation or local injection of vascular sclerosing agent can also be used to embolize the capillaries and shrink the tumor. Individual capillary hemangiomas with a wide growth range require specific analysis of specific problems.

Cavernous hemangioma: Smaller tumors can be frozen with carbon dioxide laser or liquid nitrogen. Larger tumors should be removed as soon as possible to avoid too large a range, which increases the difficulty of treatment. The range of the lesion needs to be fully assessed before surgery, and X-ray angiography can be performed if necessary. During the operation, attention should be paid to controlling bleeding and removing the hemangioma tissue as thoroughly as possible. Local injection of vascular sclerosing agents can be used as an auxiliary treatment.

Racemose hemangioma: Strive for surgical resection. X-ray angiography can be performed before surgery to understand the extent of the hemangioma in detail and make full preparations for the surgery.

For patients whose tumors are enlarged and not suitable for surgery, local injection of corticosteroids can be used 1-2 times a week, and the dosage can be reduced after the tumors shrink.