Simple cases
Case 33
A worried mother brings her 9-year-old son with a red patch on the neck
History
Has this spot been present since birth?
Yes.
One of the most common congenital malformations is the stork-bite form of nevus flammeus, located on the midline of the forehead and nape.
Does your child have any other problems?
No.
Sometimes there are deeper-lying vascular malformations in the subcutaneous fat or muscle. When a nevus flammeus is located on the face, there is a risk if glaucoma or seizures (meningeal involvement). Nevus flammeus is part of Klippel-Trenaunay and Sturge-Weber syndromes.
Does the spot itch?
No.
Nevus flammeus is usually asymptomatic.
Does it change colors?
Yes, once in a while.
Vascular lesions can become darker or lighter, as the blood vessels dilate or contract.
Did it grow in the first year of life?
Yes, it seemed to grow a little.
Nevus flammeus grows proportionally with the individual. It may expand somewhat in infancy.
Does your child have any other similar places?
No.
Most often the face or nape is involved, less often a limb.
Lesion
Choose the right efflorescences:
False. A rhagade is a fissure or tear.
False. No defect is seen here.
This flat red lesion is composed of excess blood vessels of varying sizes. It may become thickened and palpable in areas later in life.
Diagnosis
Choose the right diagnosis:
False. A lipoma is a subcutaneous fat tumor. It is palpable, but does not have a red surface.
False. A keloid is one form of excess scar tissue, always appeared a papule or nodule at a site of trauma.
False. Melanocytic nevi are tan or brown macules and papules, not seen here.
Nevus flammeus is a common harmless, generally permanent vascular malformation. It is on occasion associated with other malformations. Also called port wine stain.
Therapy
Choose the right therapy(ies):
Dermatoscopy is a way of magnifying the skin; it is not a treatment.
Cryotherapy works for hemangiomas but not for vascular malformations.
Although used formerly, this method is both dangerous and not helpful.
Both argon and dye lasers (less painful, doesn't require anesthesia) are very effective at destroying the excess vessels.
Test
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