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CONGENITAL VASCULAR LESIONS

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INSIGHT Image not available.

It is important to differentiate between the three most common vascular anomalies in newborns: capillary stains that self-resolve, port-wine stains that benefit from laser treatment, and hemangiomas, which spontaneously involute.

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CAPILLARY STAIN (SALMON PATCH)

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The salmon patch is the most common benign vascular lesion seen in infants, typically on the forehead, glabella, or nape of neck. Salmon patches are most prominent during infancy, then self-resolve during childhood.

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SYNONYMS Nevus simplex, telangiectatic nevus, “stork bite,” nuchal nevus, Unna's nevus, evanescent macule, angel kiss, or aigrette.

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EPIDEMIOLOGY
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AGE Present at birth, fades with time.

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GENDER M = F.

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INCIDENCE Occurs in 30% to 40% of newborns.

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ETIOLOGY Thought to be a persistence of fetal circulation, gradually becomes less prominent.

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HISTORY
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Present at birth, these benign lesions fade with time. In lighter skin types, the patch may be more persistent or evident during episodes of crying or physical exertion. Fifty percent of salmon patches in the nuchal region persist for life. They are asymptomatic and benign.

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PHYSICAL EXAMINATION
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Skin Findings
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TYPE Macular with telangiectasias.

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COLOR Dull pink to red.

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DISTRIBUTION Head and neck.

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SITES OF PREDILECTION Nape of neck (22%), glabella (20%) (Fig. 8-1A), and eyelids (5%).

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FIGURE 8-1
Salmon patch

A: Salmon patch on the glabella of a newborn. B: Same child at age 1 year with barely any residual vascular lesion.

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DIFFERENTIAL DIAGNOSIS
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Salmon patch is the most common vascular birthmark. Its classic locations and self-resolving tendencies should differentiate it from other vascular birthmarks such as capillary malformations and hemangiomas.

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LABORATORY EXAMINATIONS
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HISTOPATHOLOGY Skin biopsy reveals dilated dermal capillaries.

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COURSE AND PROGNOSIS
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Facial salmon patches fade with time (Fig. 8-1B) and only become evident in lighter skin types with crying or physical exertion. Nuchal salmon patches can persist but are asymptomatic and not usually of cosmetic concern because they are covered by the posterior hairline.

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MANAGEMENT
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Unlike capillary malformations, facial salmon patches fade almost completely and usually do not require treatment. Persistent lesions can occur in the nuchal area, but these are typically covered with hair and not a cosmetic concern. Rare bothersome persistent lesions can be treated with laser ablation.

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CAPILLARY MALFORMATIONS (PORT-WINE STAIN) AND ASSOCIATED SYNDROMES

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The most common capillary malformation is a port-wine stain (PWS): a lesion comprising dilated capillaries, which are macular at onset, but become plaque-like with ...

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