Vascular Birthmarks

Clinical Cases

Case 1

  • 6-month-old healthy female
  • Born at 35 weeks gestational age without complications
  • Presents for initial evaluation of a left forehead lesion involving the superior left eyelid
  • Lesion not present at birth
  • Lesion developed at 3 weeks of life and is rapidly growing
  • Lesion is asymptomatic
  • Lesion beginning to distort anatomy of the left orbit, obstructing vision

Initial evaluation

  • Clinical diagnosis: hemangioma of infancy
  • Given rapid growth, visual impediment with potential impairment of visual development, treatment is implemented
  • Prednisone 1 mg/kg/day started (note: propranolol would also be a reasonable intervention in this case if expertise in inpatient setting available)
  • Referral for ophthalmologic evaluation
  • 4-week follow-up

4-week follow-up evaluation

  • Lesion with increased pallor and flattened in appearance
  • Review of systems do not reveal any significant adverse effects of systemic corticosteroids
  • Recommendation to taper prednisone slowly over three months with interval clinical evaluation
  • Lesion involutes with no visual or cosmetic impairment

Case 2

  • 6-year-old healthy boy
  • Presents for initial evaluation of a birthmark on the right cheek
  • Lesion present at birth
  • Lesion is asymptomatic
  • Patient and parents express dislike of the cosmetic appearance of the lesion

Initial evaluation

  • Clinical diagnosis: port-wine stain (PWS)
  • No eyelid involvement (makes Sturge-Weber less likely)
  • Natural history of PWS discussed
  • Treatment options reviewed: no treatment, pulse-dye laser
  • Family chooses to pursue pulse-dye laser

Follow-up evaluation

  • Lesion appearance significantly improved after two sessions of pulse-dye laser