Birthmarks

My toddler daughter routinely expresses concern over the red birthmark on my left calf. She pats it and says, “Mommy, you have a boo-boo. Let’s put some cream on it.” She wants to “make it better” for me, to make this mark go away.

I thank her for her concern and tell her that it’s OK – it’s just a little mark on my skin called a “birthmark.” She listens as I explain, puzzled, and then looks for her own birthmark, which she doesn’t have – further compounding the mystery. 

But many of us do have birthmarks – some small and pale and barely visible, others large and disfiguring. There are two main categories of birthmarks.

• Vascular birthmarks are red or purple, raised or flat lesions that appear when blood vessels are very close to the skin. One common form is infantile hemangioma, commonly referred to as a “strawberry birthmark.” This type of birthmark can protrude from the skin. Some babies are born with infantile hemangiomas, which can grow rapidly in the first year but then slowly fade. Some vascular birthmarks, such as port-wine stains, result from capillary malformations that do not resolve over time. Other capillary malformations, such as the salmon patch (also known as an angel kiss or stork bite), are found on the forehead or back of the neck and often resolve with time.

• Pigmented birthmarks are patches and marks of a different color than the skin. Pigmented birthmarks include congenital melanocytic nevi (moles) and café au lait macules (tan patches). Giant congenital melanocytic nevi can be associated with a risk of development of melanoma, while small congenital nevi are typically benign. Café au lait macules are very common and can be benign or an indicator of a systemic disease, depending on the number and other associated factors. 

Birthmarks such as infantile hemangiomas are often a temporary phenomenon, and many fade away by age 10. But if an infantile hemangioma is near the eye, starts to grow, or is disfiguring, consult a dermatologist as soon as possible. Most permanent birthmarks don’t require treatment, but port-wine stains are often treated with vascular lasers because they can become thicker and cosmetically disfiguring over time.

It is wise to pay attention to your birthmarks and note any changes. If a birthmark is cosmetically bothersome, talk to your dermatologist to discuss treatment options, including laser. Or, you can choose to make friends with your birthmark and accept it as another kind of “fingerprint.” Birthmarks remind us of our unique, individual natures – small imperfections in a perfect organism.

My birthmark never bothered me. I rarely, if ever, thought about it. But now, it’s a connecting point with my daughter. She notices something “wrong” with me and wants to fix and love it. She gets to practice care and compassion. And I melt with her kindness and concern. Quite a big gift from a small imperfection!