Birth Marks Flashcards
What is a hemangioma (strawberry naevus)
- Benign tumour of vascular endothelium
- commonly seen at birth or within the first few weeks of life.
What do superficial hemangiomas look like
vivid red, well demarcated plaques or nodules
What do deep haemangiomas look like
skin-coloured or less well defined
What does a precusor lesion that will develop into a haemangioma look like
blanched macule, erythematous or telangtactic patch
What is the course of haemangiomas
- Pre cursor lesion
- prolifertive growth phase (6-9 months)
- Stabelisation
- Spontaneous involution (around aged 3-4)
What is the most common place for haemngiomas
60% occur on the head and neck but they can present anywhere
What should be done if >5 haemangiomas a present
- internal haemangiomatosis may be suspected if >5 lesion.
- Liver US - most common place
- brain, GIT and airway may be involved
When should you consider intervention of hemangiomas
- Haemangiomas near eyes, nose, throat, ears, airway/lips and anogenital tract should be referred
What investigations should be done to diagnose hemangioma
typicall none - clinical
If unsure dopplers or MRI can be done
US and MRI in complicated strawberry naevus
What are the complications of haemangiomas
- ulceration
- bleeding
- disfigurement
- airway obstruction
- visual disturbances
- hepatic haemngiomas associated with high output cardiac failure
What is the management of haemangioma
- Conservative
- Oral propnaolol
- topical beta-blockers - timolol
How does propanolol treat haemangiomas
beta antagnoist
- vasoconstriction
- blocking angiogenic signals such as VEGF
- Apoptosis
What should every child have before starting propanolol
- Hx inc signs ans symptoms of pulmonary and cardiac disease
- ECG + echo if bradycardic/arrythmias or Hx of familial heart disease
What are the contraindications of propanolol
- cardiogenic shock
- bradycardia
- bronchial hypersensitivity
- allergies to propanolol
What is a sebaceous naeuvus
- epidermal naevus presenting as a yellow-orange hairless patch or plaque, usually on the scalp and face
- usually oval or circular
- in Adolescence become warty and bumpy
- very rare 0.3%
Investigations of sebaceous naeuvus
biopsy if unsure.
management of sebaceous naevus
- risk of malignancy not known - some recommend excision, some watch and wait
- refer to dermatology
Complications of sebaceous Naevus
- cosmetic appearance
- chance of malignancy
- complications associated with removal
What is congenital melanocytic naevus
Proliferation of benign melanocytes which are present at birth or shortly after birth
What is the classification of congenital melanocytic naevus
Small: < 1.5 cm
Medium: 1.5–19.9 cm.
Large/giant: ≥ 20 cm
Complications of congenital melanocytic naevus
- itchiness
- ulceration
- cosmetic appearance
- risk of developing into malignant melanoma
What is Neurocutaneous melanosis
Proliferation of melanocytes in the CNS
usually assoc with giant congenital melanocytic naevus
very rare
Present as signs of raised ICP
What is acquired melancoytic naevus
Moles which appear >2yrs as flat lesions that may become elevated
Can vary in colour from pink/flesh to brown
What is halo naevus
melanocytic naevus with a white ring of depigmentation around it
Common in childhood
What diseases are associated with halo naevus
Turner syndrome.
Vitiligo
Halo naevi-associated leukoderma
What is the managment of halo naevus
benign - no management other than reassurance
What is dermal melanocytic naevus
different types of naevi that appear blue in coluor due to the presence of melanin in the dermmis
Examples of dermal melanocytis naevus
- common- raised dome shaped blue lesions
- naevus of Ota
- naevus of Ito
- mongolian Blue spot
what is Naevus of Ota
in the distribution of the opthalmic and axillary branch of the trigeminal nerve
What is a mongolion blue spot
blue/grey marking often occuring in the lumbar-sacral region
What is Naevus of Ito
On the scaupla region
What is granuloma annulare
- common inflammatory skin condition
- annular, smooth, discoloured papules and plaques
- delayed hypersensitivity reaction
- often over joints and knuckles
Clinical features of granuloma annulare
- widespread
- tender when knocked
- plaques tend to slowly change shape, size, and position
What is millia
tiny superficial pearly white papules
tiny cysts are filled with keratin
Most commonly arise on the face and affect 40-50% newboens
What is the management of millia
Tend to clear up on their own in a few months
What is molluscum contagiosum
- common viral skin infection of childhood that causes localised clusters of epidermal papules
- due to pox virus
- common in children with atopic dermatitis
What do molluscum contagisum look like
- dome shaped flesh/pink coloured papules
- waxy with a central pit
- Often arise in warm/moist areas armpit, behind the knees, groin or genital areas
- can appear on lips and eyes
Course of molluscum contagiosum
- often induces dermatitis around surrounding area causing skin to become pink, dry and itchy
- As papules resolve they become dry and scabby for 2 weeks
Complications of molluscum contagiosum
- second bacterial infection
- conjuctivitis if eyelid affected
- disseminated secondary eczema
- if immunodeficient - widespread ? HIV
- scarring
What is PHACE syndrome
- Large segmental haemangiomas usually on the head or face.
- neurocutaneous syndrome with numerous associations
What investigations should be done is suspecting PHACE
MRI/MRA brain and neck
cardiac assessment
opthalmic assessment
What does PHACE stand for
P - posterior fossa brain malformation
H - Haemangiomas - large segental fascial lesions
A - arterial anomalies
C - cardiac anoamlies, coarctation of the aorta
E - eye and endocrine abnormalties
What is the management of PHACE
- propanolol but need MRA to detect underlying arterial anomalies first - Increased risk of stroke
- MDT with derm and cardio
- TFTs if liver/parotid involvement or very large haemangiomas
