B

baldness See ALOPECIA.

bedsore See DECUBITUS ULCER.

birthmark A discoloration on a newborn’s SKIN
present at, or that emerges within a few weeks of,
birth. Birthmarks are either vascular (composed of
BLOODvessels and red in color) or pigment (patches
of skin that differ in color from the surrounding
skin). Though some birthmarks, especially large
ones, may be permanent, many fade to become
faint or unnoticeable by about age 10 years. Most
birthmarks do not present any health problems,
though large or obvious birthmarks often arouse
concern for cosmetic reasons. Occasionally vascular
birthmarks arise in sites where they can interfere
with vision (when near the EYEor on the eyelid),
BREATHING(when near the entrance to the NOSE), or
feeding (when on the lips).

Symptoms and Diagnostic Path
Most birthmarks are present at, or appear shortly
following, birth. Some vascular birthmarks may
not appear for several months after birth. When
this is the case, the birthmark appears suddenly
and grows rapidly, then remains at a steady size.
Many vascular birthmarks then disappear as the
child grows older. The doctor can identify most
birthmarks based on physical appearance. The
doctor may choose to conduct MAGNETIC RESONANCE
IMAGING(MRI) or COMPUTED TOMOGRAPHY(CT) SCAN
when there is a cavernous hemangioma because
this kind of blood vessel tumor (noncancerous)
can occur within internal organs such as the LIVER
or BRAINand creates a risk for HEMORRHAGE(uncon-
trolled bleeding), or the doctor may perform a
biopsy (take a tissue sample to examine under a
microscope) of lesions of questionable composi-

tion. Multiple café au lait spots (six or more) can

suggest NEUROFIBROMATOSIS, a genetic disorder, and

require further evaluation. Congenital dermal

melanocytosis (Mongolian spot) often has the

appearance of a large bruise (ECCHYMOSIS), some-

times raising concerns about CHILD ABUSEamong

those who are not familiar with this birthmark. A

health-care provider can quickly distinguish the

mark and determine that it is not a bruise.

Any change in the size, color, or charac-

teristics of a birthmark, especially a

NEVUS(mole), requires prompt medical

evaluation to check for malignant

melanoma or other SKIN CANCER.

Treatment Options and Outlook

Most birthmarks fade by ADOLESCENCE, making

treatment unnecessary. The doctor may choose to

surgically remove nevi (moles) that are large or in

locations where they are subject to irritation from

clothing or movement, to prevent them from

evolving to SKIN CANCER. Port wine stains (flat

hemangiomas) are often emotionally distressing

when they occur on the face. The dermatologist

may use laser therapy to shrink and seal off the

blood vessels causing the port wine stain, dimin-

ishing its prominence. Cover-up cosmetics are also

an option. Children are particularly sensitive

about having obvious birthmarks and may need

emotional support. Birthmarks are very common,

with some experts estimating that about a third of

infants are born with them.

Risk Factors and Preventive Measures

Birthmarks appear to be random and common,

with as many as a third of newborns having at

least one. Because researchers do not know what

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