Vascular Malformations

Capillary vascular malformations (telangiectatic naevi or nevi — sometimes referred to as flat hemangiomas) are damaged or malformed dialeted blood vessels in the skin. They are non-cancerous and appear as blotches of red or purplish skin discoloration on any part of the body. They are always present at birth, and become more obvious with time, varying in size from a small dot to occasionally involving a whole limb, and they grow in proportion to the child's growth.

The two most common capillary vascular malformations are the salmon patch (naevus simplex) and port wine stain (naevus flammeus). Salmon patches are very common, occurring in about 40% of all newborns. Salmon patches are small flat blotches of pink or red skin with poorly defined borders, commonly found at the nape of the neck (stork bites), on the forehead between the eyebrows (angel's kiss) or on the eyelids. The patches become more noticeable and intense in color when the child is crying. These patches often spontaneously disappear within the first year, with the exception of stork bites which may persist into the adult years. Port wine stains are less common than salmon patches, most commonly appearing on the face though they can occur anywhere on the body, generally appearing on one side of the body with a sharp mid-line cut-off. They are usually large flat patches of purple or dark red skin with well-defined borders. At birth, the stains are flat, but in time they become bumpy and more unsightly. The port-wine stains may fade over time, but most remain unchanged or may even deepen in color. They do not shrink by themselves or disappear spontaneously, and with facial or neck stains, can have a severe impact on the child's development. There are also two less common forms of vascular malformations: reticulate vascular naevi – port wine stains that usually spontaneously improve by fading over time — and angiokeratoma circumscriptum — a raised warty dark red-purple patch usually found on the lower leg or foot, covered with rough scaly patches of skin.
Most capillary vascular malformations are not associated with other abnormalities but some rare syndromes may present themselves with this kind of birthmark, such as Sturge-Weber syndrome, Parkes Weber syndrome, Klippel-Trenaunay syndrome, hyperkeratotic cutaneous capillary-venous malformation, and Proteus syndrome.

Differential Diagnosis (Other conditions with similar appearance)
Cobb Syndrome
Infantile Hemangioma
Klippel-Trenaunay-Weber Syndrome
Proteus syndrome
Rubinstein-Tavbi Syndrome

Capillary vascular malformations are usually diagnosed clinically and no investigations are necessary for the majority of patches. However, when there is uncertainty or concern, an ultrasound scan is often performed. In more complicated cases, Magnetic Resonance Imaging (MRI) or angiography can also be performed.