Pictorial case study

The case: The worried parents of a seven-week-old baby boy attended the surgery as they had noticed a red mark on his back.

The diagnosis is capillary haemangioma, also known as a strawberry naevus (Photograph: SPL)
The diagnosis is capillary haemangioma, also known as a strawberry naevus (Photograph: SPL)

They were certain that this lesion had not been present previously. The baby was well and thriving. He was delivered vaginally after his mother had an uneventful pregnancy and had no medical problems. The baby was happy and smiling.

On his upper back there was a small (20mm x 10mm), soft, raised, dark red lesion, which appeared not to be tender to touch. There were no other skin lesions.

Diagnosis and management
The diagnosis is capillary haemangioma, also known as a strawberry naevus. These lesions occur in approximately two in 100 babies. They may be present at birth but more commonly develop within two to six weeks.

They may initially be pale-coloured but then turn deep red. They are raised and have a soft texture. The size may vary considerably and while the majority are small they may grow to the size of a tennis ball. They can be anywhere on the body and occur when a certain area of skin develops an abnormal blood supply causing the affected tissues to enlarge and change colour.

The vast majority of capillary haemangiomata disappear completely by the age of eight years, but some may leave some skin wrinkling.

Since almost all disappear spontaneously by a young age, no treatment is required and the parents should be reassured. It is helpful to give them some information so that they can be assured of its benign nature and that it will disappear.

Only in rare circumstances when the haemangioma affects the vision due to its position or size, or if the child is embarrassed, is excision considered.

Possible different diagnoses

  • Port wine stain
  • Cavernous haemangioma
  • Mongolian spot
  • Cafe au lait spot

Differential diagnosis: Port wine stain:
Port wine stain differs from a capillary haemangioma as it does not disappear. It is a flat red/purple area on the skin which is caused by surplus blood vessels under the skin. It occurs anywhere on the body and may require treatment on cosmetic grounds.

  • Contributed by Dr Gwen Lewis, a GP in Windsor, Berkshire

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