Birthmark Changes

WHEN TO SEE YOUR DOCTOR

* Your birthmark changes in size, shape or color.

* Your birthmark starts to itch, burn or sting or develops bumps or sores.

What Your Symptom Is Telling You

It's not unusual for a newborn's peaches-and-cream complexion to have a strawberry garnish. A strawberry mark—one of the most common birthmarks—looks like a flattened version of its namesake that's been stuck on the skin.

Strawberry marks—and all other birthmarks for that matter—can either already be there when the baby enters the world or show up soon after birth, says Robert J. Friedman, M.D., clinical assistant professor of dermatology at New York University School of Medicine in New York City.

One change you can expect from any newborn's birthmark is growth. As the child increases in size, so does the birthmark, explains Dr. Friedman. "As a person grows from infancy to adulthood, a birthmark on the face becomes eight times larger," says Robert E. Clark, M.D., Ph.D., director of the Dermatologic Surgery and Cutaneous Oncology Unit at Duke University Medical Center in Durham, North Carolina.

Here's a primer on the kinds of changes that the most common types of birthmarks can undergo.

Strawberry marks—which get their ruddy color from blood vessels at the skin's surface—very often disappear by the time a child is six years old, says William Dvorine, M.D., chief of the Section of Dermatology at St. Agnes Hospital in Baltimore and author of A Dermatologist's Guide to Home Skin Treatment.

Port wine stains, which are often very large, are also caused by blood vessels—in this case an extensive network. In time, port wine stains can become darker, thicker and bumpy, according to Joseph G. Morelli, M.D., associate professor in the departments of dermatology and pediatrics at the University of Colorado Health Sciences Center in Denver.

A congenital nevus—a brown to brownish black mark—can range in size from very tiny to (rarely) enormous, says Dr. Morelli. A small percentage of these kinds of birthmarks become cancerous in adulthood. For that reason, they must be carefully watched for changes in size, shape or color.

Cafe au lait spots are like dashes of extra melanin (a natural brown pigment) splashed across the skin. They rarely change except possibly to get a little darker, says Dr. Dvorine. And when they do change, it's no big deal.

Symptom Relief

So suppose you notice a change in one of your birthmarks. Or suppose you want the birthmark to do a permanent disappearing act. What do you do about it?

Watch and wait. "Watching and waiting is the best technique for most strawberry marks," says Dr. Friedman. Marks that don't go away on their own can be removed by freezing, surgical excision, laser treatments or injections with a substance that collapses them.

Make stains disappear. Port wine stains were permanent—until the laser came along. "It's a wonderful development in medical science because it literally revolutionizes the lives of patients," says Dr. Clark. (Unfortunately, the treatment doesn't work as well in dark-skinned people because it can destroy pigment cells, leaving white spots.) If port wine stains show signs of growing and developing bumps, it's probably a good idea to get them removed. They aren't dangerous, but they can become increasingly unsightly.

Operate immediately. A congenital nevus that changes—a sign of a possible malignancy—is always removed surgically so it can be examined, says Dr. Dvorine. Large marks are often removed at birth as a precaution.