Macular stains. Also called salmon patches, angel kisses, or stork bites, these faint red marks are the most common type of vascular birthmark. They're often on the forehead or eyelids, the back of the neck, or on the nose, upper lip, or on the back of the head. They may be more noticeable when the baby cries. Most often they fade on their own by the time a child is 1 to 2 years old, although some last into adulthood.
Hemangiomas. Hemangiomas are classified as superficial when they appear on the surface of the skin ("strawberry marks") and cavernous when found deeper below the skin's surface. They can be slightly raised and bright red and sometimes aren't visible until a few days or weeks after a baby is born. Cavernous, deep hemangiomas may be bluish because they involve blood vessels in deeper layers of the skin. Hemangiomas grow rapidly during the first 6 months or so of life, but usually shrink back and disappear by the time a child is 5 to 9 years old. Some, particularly larger ones, may leave a scar as they regress that can be corrected by minor plastic surgery. Most are on the head or neck, although they can be anywhere on the body, and can cause complications if their location interferes with sight, feeding, breathing, or other body functions.
Vascular Malformations differ from hemangiomas in several crucial ways. Most distinctively, vascular malformations are present at birth, grow commensurately with the body, and never show signs of spontaneous involution. Photo credit.
Port wine stains are Venual Malformations. They are always present at birth and can range from pale pink to dark purple in color. These are discolorations that look like wine was spilled on an area of the body, most often on the face, neck, arms, or legs. Port wine stains can be any size, but grow only as the child grows. They tend to darken over time and can thicken and feel like pebbles in midlife adulthood unless treated. They never go away on their own. Ones near the eye must be assessed for possible complications involving the eye. In the past these lesions were erroneously called "capillary hemangiomas." Port Wine Stains occur in 0.3% of births and occur equally among males and females. The cause has been associated with a deficiency or absence in the nerve supply to the blood vessels of the affected area. These nerves control the diameter of the blood vessels. If the nerves are absent or defective, the vessels will continue to dilate and blood will pool or collect in the affected area. The result will be a visible birth mark. This is important to know because laser therapy which is used to remove a port wine stain will only be temporary. Since the deficiency is in the nervous system, in time the blood will repool in the affected area and the birthmark will once again appear. Once a Port Wine Stain is lasered, it is important at the first sign of reoccurence to have one or two treatments to keep it faded. The individual will have to have maintenance laser treatments for life. Because Port Wine Stains can be progressive, treatment should be done early to prevent cobbling of the skin and thickening and darkening of the stain. These lesions vary from low-grade to high-grade, pale to dark. Low-grade progress at a slower rate than high-grade. Rarely capillary malformations are clues to the presence of other defects such as Sturge-Weber Syndrome or Klippel-Trenaunay Syndrome.
Arteriovenous Malformations are always present at birth but are usually not noticed until later in life. Sometimes they do not appear until adulthood. Defective blood flow has been associated with these lesions. As the lesion ages, the vessels enlarge and thicken to compensate for the increased blood supply. There are two grades: low and high. Low grade grow slowly with the child and high grade expand rapidly, growing faster than the child until the lesion may eventually become life threatening. An AV malformation is a firm mass. Common sites are the lips and other head and neck areas. Mixed malformations include a combination of two or more vascular lesions.
Lymphatic Malformations used to be called cystic hygroma, hemangiolymphangioma, or lymphangiomas. Lymphatic malformations are composed of dilated lymphatic channels. The lymphatics serve as a collection and transfer system for tiisue fluids. When something disturbs this system, a lymphatic malformation is formed. The excess fluid accumulates and the affected lymphatic vessels enlarge and you see a mass. If the lymph vessels in the face are affected, the face swells because the normal active transport mechanism has been disturbed. These lesions can occur anywhere but are common in the head and neck area. These lesions may be superficial or deep (superficial ones are seen in the mouth area and look like frogs eggs) . These lesions increase or grow with the individual. They may enlarge following an upper respiratory infection.
Hemangiomas and Vascular Malformations in Infants and Children: A Classification Based on Endothelial Characteristics; The Pathogenesis of Hemangiomas: A Review; Bauland, Constantijn G. M.D.; van Steensel, Maurice A. M. M.D., Ph.D.; Steijlen, Peter M. M.D., Ph.D.; Rieu, Paul N. M. A. M.D., Ph.D.; Spauwen, Paul H. M. M.D., Ph.D.; Plastic and Reconstructive Surgery:Volume 117(2)February 2006
Progress to ward Understanding Vascular Malformations [Special Topic]; Breugem, Corstiaan C. M.B.Ch.B.; van der Horst, Chantal M. A. M. M.D., Ph.D., and; Hennekam, Raoul C. M. M.D., Ph.D.; Plastic and Reconstructive Surgery:Volume 107(6)May 2001
Vascular Birthmarks: Hemangioma and Malformations. by Mulliken, John B. MD; Young, Anthony E. MD; Textbook--W.B. Saunder, Philadelphia, PA, 1988.
Hemangiomas and Vascular Malformations of the Head and Neck edited by Milton Waner, MD and James Suen, MD--Wiley-Liss, NY 1999