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Dear Concerned Mom,

If you're one of the many moms wondering what that big, raised 'birthmark thing' on your child's body is, I don't blame you for calling my office a million times and rushing her into my clinic. I know you must be scared.

As a dad, I know that feeling of fear (don't tell my wife). As a pediatric plastic surgeon, I can confidently tell you what you're dealing with is called a hemangioma. Don't be intimidated by the word or appearance. They are not nearly as scary as you think.

Hemangiomas are large, red(ish) birthmarks that can show up in the first few weeks of life and can enlarge for up to 10-14 months. Basically, they're harmless tumors consisting of a bunch of blood vessels clumped together in the skin and fat layers. They go by many names, such as "strawberry mark" or "vascular birthmark." They usually don't appear immediately at birth (as you know from your experience), but seeing one develop can be worrisome to new parents. If I saw one for the very first time on one of my daughters (and wasn't educated about what it was), I'd be concerned too.

Fear not… hemangiomas are universally benign and are likely to shrink and fade on their own usually by the time children reach five years old. I treat them all the time.

Why did this happen? Well, after years and years of study, we still really don't know why these funny birthmarks pop up. There are many scientific theories (which I won't get into here), but we do know the following that might ease your worries: 1) They are NOT hereditary, 2) They are NOT the result of exposure to something toxic during pregnancy, and 3) They do NOT become cancerous, they do NOT spread like cancer, nor do they indicate any kind of underlying serious health problem in most cases. Good news, right?

So, now what do you do? Get a proper diagnosis. As simple as this sounds, it's sometimes tricky. While more than 90% of hemangioma cases can be identified on appearance alone (preferably by a board-certified pediatric plastic surgeon), other similar birthmarks may be mistaken for a hemangioma, such as a "Cupid's kiss" (a red mark that appears over the forehead or a "stork bite" on the nape of the neck… my daughters each had one when they were born). These are also harmless, but are starkly different in appearance and will not follow the same life cycle of a true hemangioma (which is why you really should have a specialist check it out so you know what you're dealing with from the get-go).

After getting the diagnosis right (which you have), the next step is a plan of action. What to do if it gets too big? What if it bleeds? What if the skin swells or breaks down and flakes off? Please, don't panic… these are all 'what-ifs.' Most hemangiomas can be observed until they spontaneously disappear over several years (even for large ones that are located on the chest or belly… or even the scalp, arms or legs). But what if it's on your child's face and pushing on her eye? Well… you do have the option for removing it, and there are pros and cons. My own personal philosophy (generally speaking) is that removing it is only necessary when it obstructs your child's vision or some other key function, or if it is causing some type of disfigurement​. Another option is to inquire with your specialist about the facts surrounding the medication propranolol (an adult medication for blood pressure) that has been discovered within the last several years to effectively control the growth of hemangiomas in the first year of life. However, if the hemangioma is not inhibiting your child's quality of life, I most often recommend leaving it alone… but that's just me.

My biggest message to you, as a surgeon who happens to be a dad of two little girls: Know that you're not alone and know that these birthmarks are not dangerous. One in ten children born will eventually have a hemangioma — this is quite common. Never hesitate to meet and talk with a specialist to calm your fears, but in the meantime, take a deep breath. Your baby will be fine. You will be fine. That, I can assure you.

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