The current management of vascular birthmarks.

Two vascular birthmarks are hemangiomas and vascular malformations. Hemangiomas grow by cellular proliferation. Their hallmark is rapid neonatal growth. Spontaneous regression begins when the infant is 6 to 10 months old, but it may continue until 8 to 10 years of age. Hemangiomas are infrequently life-threatening. Pharmacologic treatment is indispensible; unsightly sequelae require surgical treatment. Vascular malformations consist of dysplastic vessels and are present on a lifelong basis. They are either slow-flow (capillary, venous, lymphatic) or fast-flow anomalies with arteriovenous shunting. Complex combined vascular malformations are observed as well. Ten years ago angiographic studies clearly demonstrated the differences among the various lesions. Today a noninvasive diagnostic approach is recommended, particularly in children. Ultrasonography, Doppler flow imaging, and magnetic resonance imaging are the most informative techniques, revealing the extent of tissue involvement and differentiating fast-flow from slow-flow anomalies. Risks and management differ depending on the type of vascular malformation.