Growths and malformations of the vessels (angiomas) are collections of abnormally dense blood or lymph vessels, usually located in and below the skin, that cause red or purple discolorations.
Growths and malformations of the vessels include hemangiomas, port-wine stains, lymphangiomas, pyogenic granulomas, and spider angiomas (nevus araneus). Some appear at birth or soon afterward, and may be referred to as birthmarks. These different growths and malformations are usually recognized by their appearance, so biopsies are rarely necessary. Up to one third of all newborns have some type of growth or malformation of the vessels (vascular birthmark), most of which disappear by themselves.
Hemangiomas are abnormal overgrowths of blood vessels that can appear as red or purple lumps in the skin and on other parts of the body.
Hemangiomas of infancy develop soon after birth and tend to enlarge rapidly during the first 6 to 18 months of life. After this, they begin to shrink. About three quarters of hemangiomas disappear by age 7, although the skin that remains is often slightly discolored or scarred. Hemangiomas also develop during middle age and later, especially on the trunk.
Hemangiomas of Infancy:
These grow within and under the skin. They cause the skin to bulge and may be purple or, if they are very deep, flesh-colored. Most deep hemangiomas grow between ¼ and 2 inches (0.5 and 5 centimeters) across, although sometimes they grow much larger. More than half occur on the head and neck. Sometimes, hemangiomas develop in organs, such as the liver (see Tumors of the Liver: Hemangiomas of the Liver).
Hemangiomas of infancy do not cause pain but occasionally break open (ulcerate) and bleed. Hemangiomas around the eye may grow large enough to block vision, which can lead to permanent vision loss if uncorrected. Hemangiomas may also block the nose or throat, which can obstruct breathing.
Because hemangiomas of infancy usually go away on their own, doctors may not treat them when they first appear unless they grow rapidly, obstruct vision or breathing, ulcerate, or are cosmetically distressing.
When treatment is required, doctors prescribe oral or injectable corticosteroids or laser treatments. Surgical removal is usually not recommended because the vast majority of lesions go away on their own with less scarring when left alone. For older children in whom the hemangioma has shrunk to the greatest degree, surgery may improve the appearance of the skin.
Superficial hemangiomas (cherry angiomas or strawberry hemangiomas) are very common. They usually appear as raised, red, blood vessel growths on the torso and can number from a few to dozens. Superficial hemangiomas are harmless; if they are bothersome, a doctor can remove them with an electric needle or scalpel.
Port-wine stain (capillary malformation, nevus flammeus) is a flat pink, red, or purplish discoloration present at birth due to malformed blood vessels.
Port-wine stains are harmless, permanent discolorations. However, their cosmetic appearance may be psychologically bothersome or even devastating. They appear as smooth, flat pink, red, or purple patches of skin. Port-wine stains may be small or may cover large areas of the body. Stains that appear on the nape of the neck of newborns have been referred to as stork bites. Rarely, facial port-wine stains appear as part of the Sturge-Weber syndrome, a rare congenital disorder that can be associated with neurologic problems such as seizures and mental retardation (intellectual disability).
Small port-wine stains can be covered with cosmetic cover-up cream. If a stain is bothersome, its appearance can be greatly improved with laser therapy (see Noncancerous Skin Growths: Using Lasers to Treat Skin Problems).
Lymphangiomas (lymphatic malformations) are skin bumps caused by a collection of enlarged lymph vessels—the channels that carry lymph (a clear fluid related to blood) throughout the body.
Lymphangiomas are uncommon but usually appear between birth and age 2. They may be tiny bumps or large, deforming growths. Lymphangiomas do not itch or hurt and are not a form of cancer. Most lymphangiomas are yellowish tan, but a few are reddish. When injured or punctured, they release a colorless fluid.
Treatment is not usually needed. Removal by surgery is usually not successful since lymphangiomas grow deep and wide beneath the surface.
Pyogenic granulomas are scarlet or reddish-brown slightly raised areas caused by increased growth of capillaries (the smallest blood vessels) and swelling of the surrounding tissue.
The condition develops rapidly, usually after injury to the skin (the injury is sometimes not noticed). For unknown reasons, pyogenic granulomas may also develop during pregnancy, appearing even on the gums (pregnancy tumors). Pyogenic granulomas appear as ¼- to ½-inch (about 0.5- to 1.5-centimeter) growths that rise from the surface of the skin. They do not hurt, but they bleed easily when bumped or scratched because they consist almost entirely of capillaries.
Pyogenic granulomas sometimes disappear by themselves, but if they persist, a doctor usually removes them surgically or with an electric needle (electrocoagulation). A sample of tissue may be sent to a laboratory to ensure that the growth is not a type of skin cancer. Sometimes pyogenic granulomas recur after treatment.
Spider angiomas (also called nevus araneus, spider nevus, or vascular spiders) are small, bright red spots consisting of a central dilated blood vessel surrounded by slender dilated capillaries that resemble spider legs.
Spider angiomas on the face are commonly seen in fair-skinned people. In most people, there is no known cause, but people with cirrhosis often develop many spider angiomas, as do many women who are pregnant or who are using oral contraceptives. Spider angiomas are not present at birth.
Spider angiomas are usually less than ¼ inch (about 0.5 centimeters) across. They are harmless and cause no symptoms but may be of cosmetic concern. Spider angiomas that develop during pregnancy or oral contraceptive use usually disappear on their own 6 to 9 months after childbirth or after discontinuing oral contraceptive use. If treatment is desired for cosmetic reasons, a doctor can destroy the central blood vessel with laser therapy or with an electric needle.
Last full review/revision September 2008 by Daniel W. Collison, MD