9.3 Birthmarks Flashcards
3 main types of birthmarks?
vascular
epidermal
melanocytic
2 main vascular birthmarks?
vascular tumours
Vascular Malformations
examples of vascular tumours birthmarks?
infantile hemangioma
examples of vascular malformations?
capillary
lymphatic
Arteriovenous
who gets infantile haemangiomas more likely?
females 3:1 prematurity multiple gestation caucasian advanced maternal age, placenta paevie pre-eclampsia
when do infantile haemangiomas grow?
first 3-9 months
when is infantile haemangiomas onset?
within 1-2 weeks of birth
when does infantile haemangiomas regress?
during childhood
tell parents regression ages?
50% age 5
70% age 7
90% age 9
if uncertain about infantile haemangiomas dx?
ultrasound
two types of infantile haemangiomas?
superficial
deep
Complications of infantile haemangioma?
- Ulceration
- Interference of function: amblyopia, airway, oral
- Cosmetic disfigurement
What if the baby has a large sacral infantile haemangioma?
Spinal defects
urogenital defects
What is baby has mandibular infantile haemangioma?
Risk of sub-glottic laryngeal haemangioma impeding airway
Risk of multiple infantile haemangioma?
Underlying visceral, liver/cardiac failure
What is multiple haemangioma defined as?
More than 5
What is PHACES syndrome?
- Posterior intracranial fossa anomalies
- Haemangioma
- Aortic / arterial anomalies
- Cardiac Abnomalities
- Eye Anomalies
- Sternal defects
what kind of haemangioma in PHACES syndrome?
segmental haemangioma
investigations for mandibular haemangioma?
lateral neck x-ray
ENT exam
investigations for sacral haemangioma?
USS
MRI
investigations for multiple haemangioma?
liver U/S, doppler
MRI
investigations for PHACES haemangioma?
eye exam
MRI head & neck
ECG, ECHO
when to referral for haemangioma?
ulceration
interference of function
cosmetic - threatened
Treatment for infantile haemangiomas ulceration?
dressings
analgesia
vascular laser
Treatment for infantile haemangiomas functional or cosmetic impairment?
- propanalol
- oral steroids
- intralesional steroids
- vincristine
difference between infantile haemangiomas vs. congenital haemangiomas?
fully developed at birth
-no rapid growth phase
two kinds of congenital haemangiomas?
RICH - rapid involution
NICH - non-involuting
Rx for congenital haemangiomas - NICH?
surgical
4 kinds of vascular malformations
Capillary
Venous
Arteriovenous
Lymphatic
2 main types of capillary malformation?
- salmon patch (angel’s kiss, stork bite) 40% of newborns
2. Port Wine Stain
where are salmon patches normally?
central face usually bilateral nuchal region upper eyelid perialar region thoracolumbar
how many salmon patches usually?
multiple normally
facial salmon patches fade?
fades in 1-2 years
neck salmon patches fade?
persists into adulthood
Rx for salmon patches ?
not really unless persistent on face
Port Wine Stains incidence?
0.3%of all newborns
Port Wine Stains presents?
at birth
Port Wine Stains description?
confluent non-palpable erythema
Port Wine Stains locations?
dermatomal distribution
85% unilateral
15% bilateral
Port Wine Stains resolution?
non spontaneous
Port Wine Stains Rx?
pulsed dye vascular laser
Port Wine Stains long term complications?
darken
skin hypertrophy
nodules
all Port Wine Stains have when kind of problem?
underlying AVM, VM, LM
Limb Port Wine Stains tend to?
hypertrophy (Klippel-Trenauney)
Craniospinal Port Wine Stains need investigation?
yes
?spinal cord anomalies
how to tell if Port Wine Stains is AVM?
warm to tough, thril/pulsatile
how to tell if Port Wine Stains is VM?
bluish
dilated veins
how to tell if Port Wine Stains is LM?
vesicles, deeper swelling
what is Sturge-Weber synfrome
- Facial port wine stain, V1 or hemifacial
- ipsilateral leptomeningeal vascular malformation: epilepsy, intellectual disability etc.
- choroidal vascular malformation of the eye: glaucoma
limb Port Wine Stains manifests when? how?
- early 1-2 years
- hypertrophy of soft tissue and bones
limb Port Wine Stains syndromes?
Klippel-Trenauney (CM, VM, LM)
Parkes-Weber (CM, AVM, VM, LM)
when does Becker’s naevi appear?
at start of puberty
epidermal naevi types?
Keratinocytic Sebaceous Follicular apocrine eccrine becker's
which epidermal naevi likely to have underlying problems?
epidermal naevi syndrome
- extensive sebaceous naevi
- located in centrofacial regions
- multiple naevi
sebaceous naevi tend to develop where?
scalp
sebaceous naevi complications?
-can have growth, should be biopsied
-usually benign
-
sebaceous naevi complications occur when?
in adulthood normally
pigmented birthmarks 3 kinds:
- hyperpigmented macules
- hypopigmented macules
- congenital melanocytic naevi
hyperpigmented macules aslo known as?
cafe au lait spots
-hyperpigmented macules
-hypopigmented macules
usually follow which lines?
lines of blaschko
multiple cafe au lait spots, how many? worry about?
5<
neurofibromatosis type 1
multiple hypopigmented naevi, worry about?
tuberous sclerosis
-hyperpigmented macules treatment
no treatment
laser
-hypopigmented macules treatment
none or
cosmetic camouflage
congenital melanocytic naevi
dark spots, can have hair in them
congenital melanocytic naevi occur when?
1st year of life
congenital melanocytic naevi classification?
small <1.5cm
intermediate 1.5-19.9cm
giant >20cm
congenital melanocytic naevi single? multiple
can be multiple
congenital melanocytic naevi natural history?
- proportionate growth
- thicken & daken
- more hairs
- don’t resolve
problems with giant congenital melanocytic naevi?
- neurocutaneous melanosis
- intracerebral/leptomeningeal melanocytic proliferations
risk factors for neurocutaneous melanosis?
- > 2 congenital melanocytic naevi
- giant congenital melanocytic naevi
prognosis for neurocutaneous melanosis?
symptomatic - poor prognosis
congenital melanocytic naevi complications?
melanoma
2-3% of giant ones
highest risk
congenital melanocytic naevi complications for small ones?
no increased risk of melanoma
giant congenital melanocytic naevi investigations?
- MRI baseline or symptomatic
2. biopsy
congenital melanocytic naevi treatment
- excision
2. laser not really
