(It's been a while, but I wanted to continue providing some basic information about the medical conditions we chose for the Child of Promise program. Here's part two of that).
Last time,we took a cursory look at cleft lip and palate. This time, we'll delve into nevus and birthmarks.
Birthmarks are actually part of the group of skin lesions that are called "nevus." The term birthmark refers to what is medically known as a "congenital (present at birth) nevus." Most often, where the term "nevus" is used, it is referring to the "melanocytic nevus," or mole. This type of nevus is developed after birth and known as an "acquired nevus."
Confused? Me too. However, since the two classifications are bundled together, I'll simply refer to the specific types of birthmarks and nevi and ignore the differentiation for the time being. (Best I can tell, a birthmark is a a blemish on the skin formed before birth, whereas, a nevus is a raised lesion on the skin, acquired after birth. However, that doesn't mesh 100% with everything I've read).
Possible birthmarks/nevi include:
- Mongolian blue spots - These are a poorly defined blue-to-gray area of skin discoloration present at birth, usually in the area of the buttocks and lower spine. It may also involve other areas such as the upper back, shoulders, and arms or legs. It is present in 80% of Asian babies. These marks tend to disappear by one to two years of age, although those on the arms or legs may occasionally be permanent. The vague resemblance to a bruise has from time to time led to unfounded accusations of child abuse.
- Port-wine stain - Light pink to purple-colored birthmarks that often occur on the head or face, but can appear anywhere on the body. Closely grouped blood vessels near the surface of the skin are responsible for the color of the birthmark. It is not unusual for port wine stains to become darker over time or to develop a rough appearance. Of course, the person everyone connects with port-wine stains is Mikhail Gorbachev.
- Stork bite - This appears as a pink, flat, irregularly-shaped mark on the back of the neck, and/or the forehead, eyelids and, sometimes, the top lip. The skin is not thickened and feels no different than anywhere else on the body; the only difference remaining in appearance. Nearly half of all babies have such a birthmark. However, most fade by the end of the infant's first year, and there are no known health problems.
- Cafe-au-lait spots - Flat, sharply demarcated, evenly pigmented flat spots that are more or less oval. They are light to medium brown, as reflected by the name. They are usually present at birth, but may arise later in the first few years of life. To have a few such spots is totally normal, however a significant number of large spots of this type can be diagnostic of neurofibromatosis.
- Nevus spilus - Nevus spilus is a small light brown spot, which resembles somewhat a cafe-au-lait spot, but which contains speckles and bumpy nodules. It is benign.
- Hemangioma - The most common type of birthmark (though not as much in Asian infants as Caucasian infants). Hemangiomas are connected to the circulatory system and filled with blood. The appearance depends on location. If they are on the surface of the skin they look like a ripe strawberry, if they are just under the skin they present as a bluish swelling. Sometimes they grow in internal organs such as the liver or larynx. In most cases, hemangiomas will disappear over time. They are often misdiagnosed, initially, as a scratch or bruise but the diagnosis becomes obvious with further growth.
- Spitz nevus - a brown to pink dome-shaped nodule that arises commonly in children on the head, neck or arm region. It may mimic melanoma in outward appearance but is benign.
- Blue Nevus - These are blue in color because they are positioned deep within the skin, and appear to be a ‘bruise’. They can range in appearance from flat to slightly raised, and they are usually small in size. (I can't tell if this is specifically different than Mongolian spots or not).
(Explanations thanks to
wikipedia,
drhull.com, and
rainbowkids.com)
As with any mole-like growth, a child with birthmarks may be prone to skin cancers. Thus, they need to be sure to wear sunscreen, have limited exposure time in direct sunlight, and have regular checkups with a physician. If any nevus changes in shape, color, or size, a physician should monitor it. If the edges of the birthmark become irregular in shape or discomfort develops, a physician should inspect the area, possibly removing it and evaluating it for cancerous cells.
For all of these, no surgery should be necessary, unless the birthmark shows signs of a melanoma. Fortunately, we have access to a dermatologist at OHSU, a trusted expert that we will be able to consult with if our child has a birthmark or nevus that needs attention.
