Pediatric Benign Skin Growths and Pigmentation Disorders

Birthmarks are areas of discolored or raised skin that are seen at birth or within a few weeks of birth. Birthmarks may be made up of malformed pigment cells or blood vessels.

Medical experts don’t know what causes birthmarks. But most of them are not cancer (benign) and don't require treatment. Babies with birthmarks should be checked and diagnosed by a healthcare provider.

These are the most common types of vascular birthmarks:

• Macular stains or salmon patches. These are characterized by pink to red marks that may appear anywhere on the body. Angel kisses and stork bites are the most common type of vascular birthmark:
  
  • Angel's kisses. Marks located on the forehead, nose, upper lip and eyelids that usually disappear with age.
  • Stork bites. Marks on the back of the neck that may disappear with age.
• Hemangioma. These are a common vascular birthmark. Hemangiomas become visible within the first few weeks or months of life and continue to grow rapidly for about 6 to 9 months. Then they slowly lose this red color and shrink. They are called strawberry patch hemangiomas. By age 5, 50% of these go away and 90% go away by age 9 without any treatment. Hemangiomas that grow into other organs or structures or become ulcerated should be checked by your healthcare provider.
• Port-wine stain. A port-wine stain is a flat, pink, red or purple mark that appears at birth, often on the face, arms and legs. It continues to grow as the child grows. Port-wine stains don't go away, and may become more purple or thicker with age. These birthmarks often need treatment if located on the eyelid or forehead. Port-wine stains involving the face may cause eye problems and be linked with other developmental disorders.

These are the most common types of pigmented birthmarks:

• Moles. These can be skin-colored, brown or black, flat or raised, and small or large. They can happen anywhere on the body. Moles can also happen in adulthood. But only moles that are present at birth are considered birthmarks. Other moles can appear within the first 2 years of life. Moles can develop into cancer later in life. Larger moles have a higher risk of becoming cancerous.
• Cafe-au-lait spots. This is French for coffee with milk. These are usually oval-shaped and light brown. Typically these fade with age and are not a problem. But many of them grouped together can be a sign of other health issues and should be checked by a healthcare provider. 
• Mongolian spots. These are blue or blue-gray spots on the lower back or buttocks. They are most common in babies with darker skin, such as African-American or Asian babies. They can be mistaken for bruises. They usually fade with age.

As a child grows older and is exposed to sunlight, the skin changes. Benign skin growths mean they aren’t cancer. Children may have freckles and moles. These may multiply or darken over time in response to sun exposure. Check with a healthcare provider if your child develops any skin changes.

Dermatofibromas

• Small, firm, red or brown scar-like bumps caused by a buildup of fibroblasts (soft tissue cells under the skin). They often happen on the legs and may itch. They often result from trauma, like a bug bite.
• Treatment: Dermatofibromas can be surgically removed if they become painful or itchy.

Dermoid cysts

• A noncancerous (benign) tumor that is made up of hairs, sweat glands, and oil (sebaceous) glands. Some internal dermoid tumors may even contain cartilage, bone fragments, and teeth. These are rare and are usually present at birth.
• Treatment: Dermoid cysts may be surgically removed for cosmetic reasons or if they are causing a problem, such as on an eyelid.

Freckles

• Darkened, flat spots that typically appear only on sun-exposed areas of the skin. Freckles are common in people with blond or red hair.
• Treatment: No treatment is needed for freckles.

Keloids

• Smooth, firm, raised, fibrous growths on the skin that form in wound sites. Keloids are more common in African-Americans.
• Treatment: Keloids respond poorly to most treatment approaches. Injections of corticosteroid drugs may help to flatten the keloids. Other treatment approaches may include surgery, laser or silicone patches to further flatten the keloids.

Lipomas

• Round or oval lumps under the skin caused by fatty deposits. They tend to appear on the forearms, torso and back of the neck.
• Treatment: Lipomas are generally harmless. But if the lipoma changes shape, a biopsy may be advised. Treatment may include surgical removal if the lipoma bothers the child.

Moles (nevi)

• Small skin marks caused by pigment-producing cells in the skin. Moles can be flat or raised, smooth or rough, and some contain hair. Most moles are dark brown or black. Some are skin-colored or yellowish. Moles can change over time and often respond to hormonal changes.
• Treatment: Most moles are benign and no treatment is needed. Some benign moles may develop into skin cancer (melanoma). See "atypical moles (dysplastic nevi)" for signs.

Atypical moles (dysplastic nevi)

• Atypical moles are larger than normal moles), and are not always round. Atypical moles can be tan to dark brown, on a pink background. These types of moles may happen anywhere on the body.
• Treatment: Treatment may include removal of any atypical mole that changes in color, shape, or diameter. People with atypical moles should avoid sun exposure, since sunlight may accelerate changes in atypical moles. People with atypical moles should talk with a healthcare provider for any changes that may indicate skin cancer.

Pyogenic granulomas

• Red, brown or bluish-black, raised marks caused by excessive growth of capillaries (small blood vessels) and swelling. Pyogenic granulomas usually form after an injury to the skin. They tend to bleed easily.
• Treatment: Some pyogenic granulomas disappear without treatment. Sometimes, a biopsy is needed to rule out cancer. Treatment may include surgical removal.

Epidermoid cysts

• Also called epidermal inclusion cysts, these are common benign lumps that most often don't cause discomfort unless they become inflamed or infected. They range from a half to two inches in size and are common on the back, head and neck. They are firm and contain a white substance.
• Treatment: Treatment to remove the cyst is not needed unless the cyst becomes inflamed, or if its location is a problem. Epidermoid cysts generally go away without treatment but may return.

Skin color is determined by a pigment (melanin) made by specialized cells in the skin (melanocytes). The amount and type of melanin determines a person's skin color.

Melanin's role is to protect DNA in body cells from sun damage. It gives color to the skin, hair and irises of the eyes. Levels of melanin depend on race and amount of sunlight exposure. Sun exposure increases melanin production to protect the skin against harmful UV (ultraviolet) rays. In addition, hormone changes can affect melanin production.

Albinism

• This is a rare, inherited disorder. It reduces the amount of melanin pigment in the skin, hair, and eyes. People with albinism (albinos) have white hair, pale skin, and pink or blue eyes. Their eyes may seem red in different lighting conditions. Many also have vision problems.
• Treatment: There is no cure for albinism. People with this condition should avoid sun damage to the skin and eyes by wearing sunscreen, hats and sunglasses.

Melasma

• This causes dark brown to gray-brown, symmetric patches of pigment on the face. During pregnancy, this is called the mask of pregnancy. Sun exposure, hormones and birth control pills are thought to cause melasma.
• Treatment: Sunscreens and avoiding sun exposure can prevent melasma from getting worse. Other treatment may include prescription creams containing hydroquinone and tretinoin to lighten the patches. Chemical peels and laser treatment can also be used.

Pigment loss after skin damage

• Sometimes after an ulcer, blister, burn or infection, the skin does not replace some of the pigment in that area.
• Treatment: No treatment is needed. Makeup can usually cover the blemish.

Vitiligo

• This causes smooth, white patches on the skin. It is caused by the loss of pigment-producing cells in the skin (melanocytes). It's thought to be an autoimmune disease. The white patches are very sensitive to the sun.
• Treatment: Treatment may include covering smaller patches with makeup or long-lasting dyes, light-sensitive medicines, UV light therapy, corticosteroid creams, surgery and removing the remaining pigment from the skin (depigmentation) so that white areas are less obvious.