vascular lesions:

• haemangiomas

  • benign tumours resulting from proliferation of cells of vascular endotherlium

    • characterised by groth phase

    • involutional phase

  • vascular malformations

    • developemntal defects

    • remain relatviely static

• differnet prognosis

Haemangioma/ Strawberry naevus

• most common soft tissue tumour

  • 5-10% of 1yr old

  • F>M 3:1

  • 20% involve multiple lesions

• start soon after birth as a red pinpoint lesion

  • 55% present at birth

• grow rapidly for first 6mo

  • involute and become pale

• full resolution several years

  • up to 10yrs

• reassure

• demonstrate how to stop bleeding

• possible treatments

  • oral or intralesional steroids

  • vascular laser

  • interferon

  • surgery

    • not suually necessary

• exceptions;

  • periorbital

  • nose

  • lips

  • face

• refer leson on eyelid

  • risk to vision

  • amblyopia

• stridor + haemangioma on face (in beard distribution) = laryngeal haemorrhage

Port wine stain (Naevus Flammeus)

• malformations of superficial capillaries of skin

• present from birth

• do not proliferate after birth

• can be localised to any body surface

  • facial lesions most common

• surgical intervention inadvisable

• pulsed dye laser

  • initiiated in first 2 years

• most are isolated defects

• can be associated with Sturge-Weber syndrome

  • facial port-wine stain

    • V1 distribution

  • leptomeningeal angiomatosis

  • mental retardation

  • seizures

  • hemiparesis contralateral to facial lesions

  • ipsilateral intracortical calcification

Transient mcaular stains (salmon patches)

• stork bites, angels’ kiss

• 70% of normal new born

• red irregular macular patches

• most facial lesions fade by 1yr

• lesions on neck may persist for life

Venous malformations

• aggregations of abnormal subcutaneous veins

  • may infiltrate deeper tissues

• were treated surgically

• now specialist sclerosant agents

Lymphatic malformations

• cystic tumour on neck, face and oral cavity

• tend to enlarge

• previously known as cystic hygroma

pigmented lesions

Dermal melanosis (mongolian spot)

• most common

• 70-96% of african american, asian,

• 5% white infants

• entrapment of melanocytes in dermid during migration from neural crest into epidermis

• associated with cleft lip, spinal meningeal tumour, melanoma

• usually benign

Cafe au lait macules

• pigmented macules with smooth borders

• develop throughout childhood

• very light brown to chocolate brown

• up to 5 found in 1.8% of children and 25-40% of normal children

  • no signficantce

• >6 (0.5cm or >1.5cm in puberty) especially when accompanied by freckling in flexural creases

  • should be evaluated for neurofibromatosis type 1

congenital naevi

• 1-2% born melanocytic naevi

• giant naevi

  • dermabraded @ ideally less than 6wk

  • would be approx 20cm in length in adult

    • 5-12cm in new born

    • may occupy 15-35% of body surgace

  • trunk/head/neck

  • malignant melanoma in 2-10% of affected in lifetime

Benign juvenile melanoma

• face

• usually excised

  • rapid growth and family concerns