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Pediatric Benign Skin Growths and Pigmentation Disorders

Abnormal skin growths and abnormal pigmentation of the skin may be present at birth or develop later in life. Although harmless in most cases, skin growth and pigmentation disorders should be monitored closely for any changes that may indicate a development of cancerous skin cells.

There are many types of skin growths and pigmentation disorders that require clinical care by a physician or other healthcare professional. The most common are listed below.

For more information on skin growths, or to find information about conditions not listed, visit the Dermatology Resources for Families, Useful Web Sites section.

What are birthmarks?

Birthmarks are areas of discolored and/or raised skin that are apparent at birth or within a few weeks of birth. Birthmarks are made up of malformed pigment cells or blood vessels. About 10 in every 100 babies have vascular birthmarks (birthmarks made up of blood vessels).

Although the cause of birthmarks is not known, most of them are benign (non-cancerous) and do not require treatment. For safety, however, all babies with birthmarks should be examined and diagnosed by a physician.

What are the most common types of vascular birthmarks?

This list includes the most common types of vascular birthmarks:

  • Flat stains (also known as “angel's kisses or stork bites)
    The most common type of vascular birthmark, characterized by pink to red marks that may appear anywhere on the body
    • Angel's kisses: marks located on the forehead and eyelids, which usually disappear after age 2
    • Stork bites: marks on the back of the neck, which may last into adulthood
  • Hemangioma. A common vascular birthmark. Hemangiomas become visible within the first few weeks of life and continue to grow rapidly for about six to nine months. Then they gradually lose their red color and shrink in size. They are called strawberry hemangiomas.
  • Port-wine stains. A port-wine stain, also called a nevus flammeus, is a flat, pink, red, or purple mark that appears at birth, often on the face, arms, and legs, and continues to grow as the child grows. Port-wine stains do not go away and often require treatment if located on the eyelid or forehead. Port-wine stains on the face may cause eye problems.

Other Benign Skin Growths

What are other benign skin growths?

As a person grows older and is exposed to sunlight, the skin changes. Children may have freckles and moles, which may multiply or darken over time.

What are the different types of skin growths?

Skin GrowthCharacteristicsTreatment
Small, firm, red or brown bumps caused by an accumulation of fibroblasts (soft tissue cells under the skin). They often occur on the legs and may itch.
Dermatofibromas can be surgically removed if they become painful or itchy.
Dermoid CystA benign tumor which contains hair, sweat glands, and sebaceous glands. Some internal dermoid tumors may contain cartilage, bone fragments, and teeth.
Dermoid cysts may be removed surgically for cosmetic reasons.
Freckles Darkened, flat spots that typically appear only on sun-exposed areas of the skin. Freckles are common in people with blond or red hair.
No treatment is necessary for freckles.
Smooth, firm, raised, fibrous growths on the skin that form in wound sites. Keloids are more common in African-Americans.
Keloids respond poorly to most treatment approaches. Injections of corticosteroid drugs may help to flatten them. Other treatment options include surgery or silicone patches to further flatten the keloids.
Round or oval lumps under the skin caused by fatty deposits. Lipomas are more common in women and tend to appear on the forearms, torso, and the back of the neck.
Lipomas are generally harmless, but if the lump changes shape, the physician may perform a biopsy. Treatment may include removal by surgery.
Moles (nevi)
Small skin marks caused by pigment-producing cells in the skin. Moles can be flat or raised, smooth or rough, and some contain hair. Most moles are dark brown or black, but others are skin-colored or yellowish. Moles can change over time and often respond to hormonal changes.Most moles are benign and no treatment is necessary. However, some benign moles can develop into skin cancer (melanoma).
Atypical Moles (dysplastic nevi) Larger than normal moles (more than one half inch across), atypical moles can be round or irregular in shape. Colors range from tan to dark brown, on a pink background. Atypical moles can occur anywhere on the body.Treatment may include removal of any atypical mole that changes in color, shape, and/or diameter. People with atypical moles should avoid sun exposure, since sunlight can accelerate changes in those moles. Anyone with atypical moles should consult a physician with any changes that may indicate skin cancer.
Pyogenic GranulomasRed, brown, or bluish-black raised marks caused by excessive growth of capillaries (small blood vessels) and swelling. Pyogenic granulomas usually form after an injury to the skin.Some pyogenic granulomas disappear without treatment, while in other cases a biopsy is necessary to rule out cancer. Treatment may include surgical removal.

Distinguishing benign moles from melanoma

According to recent research, certain moles are at higher risk for changing into cancerous growths, including malignant melanoma, a form of skin cancer. Moles that are present at birth and atypical moles have a greater chance of becoming malignant. Recognizing changes in any moles, by following this ABCD Chart, is crucial in detecting malignant melanoma or other cancerous skin growths at their earliest stage of development. The warning signs are:

  • Asymmetry: When half of the mole does not match the other half.

  • Border: When the border (edges) of the mole are ragged or irregular.

  • Color: When the color of the mole varies throughout.

  • Diameter: If the mole's diameter is larger than a pencil's eraser.

Skin Pigment Disorders

What are skin pigment disorders?

Skin color is determined by pigment (melanin) made by specialized cells in the skin called melanocytes. The amount and type of melanin determines a person's skin color.

What is the function of melanin?

Melanin gives color to the skin, hair, and the iris of the eyes. Levels of melanin depend on race and amount of sunlight exposure. Sun exposure increases melanin production in order to protect the skin against harmful ultraviolet rays. In addition, hormonal changes can affect melanin production.

What are the different types of skin pigment disorders?

Pigment DisorderCharacteristics Treatment
Albinism This rare, inherited disorder is characterized by a total or partial lack of melanin in the skin, compared to the pigmentation of siblings and parents. Albinos (people with albinism) have white hair, pale skin, and pink eyes. Vision is often affected. There is no cure for albinism. Albinos should avoid sunlight because they lack natural protection from sunlight (melanin).
Pigment loss after skin damage Sometimes following an ulcer, blister, burn, or infection, the skin does not replace some of the pigment in that area. No treatment is necessary. Cosmetics can usually cover the blemish.
Vitiligo Smooth, white patches in the skin. Vitiligo is caused by the loss of pigment-producing cells in the skin (melanocytes). The white patches are very sensitive to the sun. There is no cure for vitiligo. Treatment may include covering smaller patches with long-lasting dyes, light-sensitive drugs, ultraviolet A light therapy, corticosteroid creams, and depigmentation of the remaining skin.

Skin Cancer

What is skin cancer?

Skin cancer is a malignant tumor that grows in the skin cells. Skin cancer accounts for 50 percent of all cancers. Melanoma, the most serious type of skin cancer, accounted for about 62,190 cases of skin cancer in 2006. Furthermore, melanoma accounted for most (nearly 8,000) of the 10,710 deaths due to skin cancer in 2006, according to the American Cancer Society.

Fortunately, skin cancers (basal cell and squamous cell carcinoma, as well as malignant melanoma) are rare in children. When melanomas occur, they usually arise from pigmented nevi (moles) with the following characteristics:

  • Large (diameter greater than 6 mm)
  • Asymmetric
  • Irregular borders
  • Irregular coloration

Bleeding, itching, and a mass under the skin are other signs of cancerous change. If a child has had radiation treatment for cancer, nevi in the radiated area are at increased risk of becoming cancerous.

What causes skin cancer?

Exposure to sunlight is the major contributing factor to developing skin cancer later in life. In particular, blistering sunburns in childhood and adolescence significantly increase the risk of developing malignant melanoma.

Most people receive more than 50 percent of their lifetime ultraviolet (UV) dose by the age 20. Limiting exposure to sunlight in children and teens may pay large dividends in preventing cancers later in life.

What are the different types of skin cancer?

There are three main types of skin cancer, including:

  • Basal cell carcinoma accounts for approximately 75 percent of all skin cancers. This highly treatable cancer starts in the basal cell layer of the epidermis (the top layer of skin) and grows very slowly. Basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin - mainly those areas exposed to the sun, such as the head, neck, arms, hands, and face. It commonly occurs among persons with light-colored eyes, hair, and complexion.
  • Squamous cell carcinoma although more aggressive than basal cell carcinoma, is highly treatable. It accounts for about 20 percent of all skin cancers. Squamous cell carcinoma may appear as nodules or red, scaly patches of skin, and is usually found on the face, ears, lips, and mouth. Squamous cell carcinoma can spread to other parts of the body. This type of skin cancer is usually found in fair-skinned people.
  • Malignant melanoma accounts for only 4 percent of all skin cancers, but 79 percent of deaths from skin cancer. Malignant melanoma starts in the melanocytes cells that produce pigment in the skin. Malignant melanoma usually begins as a mole that then turns cancerous. This cancer may spread quickly. Malignant melanoma most often appears on fair-skinned men and women, but persons with all skin types may be affected.

Distinguishing benign moles from melanoma

Melanomas vary greatly in appearance. Some melanomas may show all of the ABCD characteristics, while other may only show changes in one or two characteristics. Always consult a physician for a diagnosis.

What are the risk factors for melanoma?

Skin cancer is more common in fair-skinned people, especially those with blond or red hair and light-colored eyes. However, no one is safe from skin cancer. Almost half of all Americans who live to age 65 will be diagnosed with skin cancer at some point in their lives, according to the National Cancer Institute.

Other risk factors include:

  • Family history of melanoma
  • Sun exposure (the amount of time spent unprotected in the sun directly affects a child's risk of skin cancer)
  • Early childhood sunburns (research has shown that sunburns early in life increase a child's risk for skin cancer later in life)
  • A large number of freckles
  • A large number of ordinary moles (more than 50)
  • Atypical moles (dysplastic nevi)

What can be done to prevent skin cancer?

The American Academy of Dermatology (AAD) has declared war on skin cancer by recommending these three preventive steps:

  • Wear protective clothing, including a hat with a four-inch brim.
  • Apply sunscreen all over the child's body and avoid the midday sun from 10 a.m. to 4 p.m. (Keep infants under 6 months of age out of direct sunlight at all times.)
  • Regularly use a broad-spectrum sunscreen with an SPF of 15 or higher, even on cloudy days.

The following six steps have been recommended by the AAD and the Skin Cancer Foundation to help reduce the risk of sunburn and skin cancer:

  • Minimize exposure to the sun at midday - between the hours of 10 a.m. and 4 p.m.
  • Apply sunscreen, with at least a SPF-15 or higher that protects against both UVA and UVB rays, to all areas of a child's (older than 6 months of age) body that are exposed to the sun.
  • Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or perspiring.
  • Make sure the child wears clothing that covers the body and shades the face. Hats should provide shade for both the face and back of the neck. Wearing sunglasses will reduce the amount of rays reaching the eyes by filtering as much as 80 percent of the rays, and protecting the lids and the lens.
  • Avoid exposure to UV radiation from sunlamps or tanning parlors.
  • Protect children from excessive sun exposure when the sun is strongest (between 10 a.m. and 4 p.m.), and apply sunscreen liberally and frequently to children 6 months of age and older.

The American Academy of Pediatrics (AAP) approves of the use of sunscreen on infants younger than 6 months old if adequate clothing and shade are not available. Parents should still try to avoid sun exposure and dress the infant in lightweight clothing that covers the skin. However, parents also may apply a minimal amount of sunscreen to the infant's face and back of the hands.

Remember, sand and pavement reflect UV rays even under the umbrella. Snow is a particularly good reflector of UV rays. Reflective surfaces can reflect up to 85 percent of the damaging sunrays.

How to perform a skin examination

Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. Examining children is usually the first step in detecting skin cancer. The following suggested method of examination comes from the American Cancer Society:

  • Examine the child's body front and back, then the right and left sides, with arms raised
  • Look carefully at the child's forearms, the back of the upper arms, and the palms of the hands
  • Look at backs of the legs and feet, spaces between the toes, and the soles of the feet
  • Examine the back of the neck and scalp
  • Check the back and buttocks
  • Become familiar with the child's skin and the pattern of moles, freckles, and other marks
  • Be alert to changes in the number, size, shape, and color of pigmented areas
  • Follow the ABCD Chart when examining moles of other pigmented areas and consult the child's physician promptly if any changes occur

Treatment for Skin Cancer

What are the treatments for skin cancer?

Specific treatment for skin cancer will be determined by the child's physician based on the following:

  • The child's overall health and medical history
  • Extent and type of the disease
  • The tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Child or parent’s opinion or preference

There are several kinds of treatments for skin cancer:

  • Surgery
    Surgery is a common treatment for skin cancer, and it is used in about 90 percent of treated cases. Some types of skin cancer growths can be removed very easily and require only very minor surgery, while others may require a more extensive surgical procedure.

    Surgery may include the following procedures:
    • Cryosurgery
      Cryosurgery uses an instrument that sprays liquid nitrogen onto the skin, freezing and destroying the tissue.
    • Curettage and electrodesiccation
      This common type of surgery involves scraping away skin tissue with a curette (a sharp surgical instrument), then cauterizing the wound with an electrosurgical unit.
    • Excision
      A scalpel (sharp surgical instrument) may be used to excise and remove the growth. The wound is usually stitched or held closed with skin clips.
    • Mohs' microscopically-controlled surgery
      This type of surgery involves excising a lesion, layer by layer. Each piece of excised tissue is examined under a microscope. Tissue is progressively removed until no tumor cells are seen. The goal of this type of surgery is to remove all of the malignant cells and as little normal tissue as possible. It is often used with recurring tumors.
    • Laser therapy
      Laser surgery uses a narrow beam of light to remove cancer cells, and is often used with tumors located on the outer layer of skin.
  • Radiation therapy
    X-rays are used to kill cancer cells and shrink tumors.
  • Chemotherapy
    Chemotherapy uses drugs to kill cancer cells. There are two main types:
    • Topical chemotherapy
      chemotherapy given as a cream or lotion placed on the skin to kill cancer cells
    • Systemic chemotherapy
      chemotherapy administered orally or intravenously (IV)
  • Immunotherapy
    This complex type of treatment involves various approaches to boost the body's own immune system, helping it to slow the growth of the cancer.



The Division of Dermatology at Children's National Hospital continues to expand services as more families seek our expertise in the diagnosis and treatment of disorders of the skin, hair and nails.

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