Although most birthmarks are small and harmless, some are large and can cause cosmetic or functional impairment. Others can indicate an underlying abnormality, and a few have malignant potential. Some birthmarks can be removed, but others remain a challenge to treat even with present surgical and laser techniques.
- ‘Birthmark’ is a lay term that encompasses many skin conditions, including malformations, neoplasms and hamartomas; not all are obvious at birth.
- The risk of melanoma in children is low; most melanocytic naevi are removed for cosmetic reasons, not malignancy.
- Naevus sebaceous is the most common epidermal naevus and one of the few with a malignant potential.
- Most haemangiomas are uncomplicated, requiring no intervention; however, facial haemangiomas need to be carefully observed over time as even a modest increase in size can cause substantial problems.
- The ‘gold standard’ treatment for haemangiomas that are large, ulcerated, likely to cause deformity or affecting an orifice is oral propranolol.
- Children with capillary malformations (port wine stains) may be treated with pulsed dye laser therapy and should be referred for assessment as early as possible.
- Most small birthmarks can be removed; however, the decision should be postponed in most cases until the child can be involved in decision making.