Proper Diagnosis Key to Successful Treatment of Facial Birthmark in Young Children
Watchful Waiting is Often Best, but Plastic Surgery May Help Avoid Physical and Emotional Issues with Hemangioma
Tarrytown, NY, March 7, 2013 – A reddish birthmark that appears on a baby’s skin in the first few weeks after birth is most often harmless, but should be brought to a physician’s attention. While blemishes in babies are rare, in some a red-purple raised birthmark called a “hemangioma” could develop on the face, neck or scalp. Hemangioma is the most common tumor of infancy, but is benign, or non-cancerous.
Yet a hemangioma can cause concern for parents watching it grow rapidly on their child’s skin. It’s helpful to understand the typical course of hemangioma growth and treatment options—which range from “watchful waiting” to plastic surgery—to ensure appropriate care and the best outcome for the child.
More girls than boys develop hemangiomas, which are also more common in twins; in Caucasian than Asian children; and very rare in African-American children. Overall, hemangiomas will occur in four to ten percent of children born in the United States.
A hemangioma appears at or soon after birth as a reddish blush on the skin. It grows rapidly for the first three to four months, then more slowly up to one year of age. The blood vessels that make up the hemangioma provide its reddish-purple color.
“Parents should rest assured that most babies won’t develop a hemangioma, and for those that do it will likely stop growing around one year of age and then actually shrink,” said Tae Ho Kim, M.D., assistant professor at New York Medical College and Chief of Pediatric Plastic and Craniofacial Surgery at the Maria Fareri Children's Hospital at Westchester Medical Center, and a plastic surgeon with the New York Group for Plastic Surgery. “A small, flat hemangioma will fade away over a few years without any scar or skin deformity. Sometimes oral medication is used to reduce the size of a hemangioma. Laser treatment may help remove remaining reddish areas.”
When to Consider Surgical Intervention for Hemangioma
Sometimes a child’s hemangioma becomes quite large and bulging. Well-intentioned pediatricians may tell parents the birthmark will shrink over time without a visible scar or disfigurement. While it will shrink from its largest size, a very large hemangioma can leave behind residual scars and loose, spongy skin and soft tissue. After five to seven years, the remaining hemangioma can result in physical disfigurement, such as a sagging cheek or lip or a bulging nose.
“In our image-conscious society, looking normal or attractive is one important component to the psychological and emotional well-being of a child,” said Dr. Kim. “A child as young as two years old is self-aware and recognizes that something about him or her is ‘different’. A noticeable deformity, especially on the face, can negatively impact a child’s self-esteem during critical years of development.”
He added that a large hemangioma on a child’s face, scalp or neck can be very difficult for parents as well. Parents feel frustrated and sad if their child is teased, and confront negative comments or long stares from family and strangers alike.
Early surgical intervention—at eight months to one year of age—to remove a large hemangioma can correct a visible facial deformity that wouldn’t go away on its own; provide many years for the surgical scar to mature and fade; and prevent years of negative comments and teasing.
Dr. Kim suggested that parents keep in mind the following about children’s hemangiomas:
• The vast majority of babies or infants won’t develop a hemangioma. For those who do, the birthmark is not cancerous and can be managed with observation or medical treatment when necessary.
• Most hemangiomas are small and flat, and eventually go away without medical interference. Most hemangiomas will shrink significantly by five to ten years of age. So when a pediatrician says, ‘don’t worry, this birthmark will go away’, it’s good advice. But if a parent is concerned about the growing size of a hemangioma, they should seek the expertise of a pediatric plastic surgeon.
• Parents can explain to young children that their hemangioma is a birthmark and cannot hurt them or be contagious to others, and that as they get older it will go away on its own or with a doctor’s help.
• Sometimes a hemangioma will grow very fast and large, and if untreated can leave a child with permanent scarring or disfigurement. Operating early may be the most beneficial treatment if done by an experienced pediatric plastic surgeon.