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Feature Article

Common skin problems in children. Part 4: birthmarks

Gayle Fischer

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Abstract

Although most birthmarks are small and harmless, they can sometimes be large and cause cosmetic or functional impairment. Others can indicate an underlying abnormality, and a few have a malignant potential. Some birthmarks can be removed, but others remain a challenge to treat even with present surgical and laser techniques.

Key Points

  • ‘Birthmark’ is a lay term that has many medical equivalents, including neoplasms, hamartomas and malformations; not all are present at birth.
  • Although most haemangiomas are uncomplicated, requiring no intervention, patients with facial haemangiomas need to be carefully observed; even a modest increase in size of these lesions can lead to substantial problems.
  • The risk of melanoma in children is low; most melanocytic naevi are removed for cosmetic reasons, not malignancy.
  • Children with capillary malformations (port wine stains) may be treated successfully with laser therapy; they should be referred for assessment by the age of 12 months.
  • Naevus sebaceous is the most common epidermal naevus and one of the few with a malignant potential.
  • Most small birthmarks can be removed; the decision to remove birthmarks should, in most cases, involve the child.

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