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Case 33

A worried mother brings her 9-year-old son with a red patch on the neck


One of the most common congenital malformations is the stork-bite form of nevus flammeus, located on the midline of the forehead and nape.


Sometimes there are deeper-lying vascular malformations in the subcutaneous fat or muscle. When a nevus flammeus is located on the face, there is a risk if glaucoma or seizures (meningeal involvement). Nevus flammeus is part of Klippel-Trenaunay and Sturge-Weber syndromes.


Nevus flammeus is usually asymptomatic.

Yes, once in a while.

Vascular lesions can become darker or lighter, as the blood vessels dilate or contract.

Yes, it seemed to grow a little.

Nevus flammeus grows proportionally with the individual. It may expand somewhat in infancy.


Most often the face or nape is involved, less often a limb.

Choose the right efflorescences:

False. A rhagade is a fissure or tear.

False. No defect is seen here.

This flat red lesion is composed of excess blood vessels of varying sizes. It may become thickened and palpable in areas later in life.

Choose the right diagnosis:

False. A lipoma is a subcutaneous fat tumor. It is palpable, but does not have a red surface.

False. A keloid is one form of excess scar tissue, always appeared a papule or nodule at a site of trauma.

False. Melanocytic nevi are tan or brown macules and papules, not seen here.

Nevus flammeus is a common harmless, generally permanent vascular malformation. It is on occasion associated with other malformations. Also called port wine stain.

Choose the right therapy(ies):

Dermatoscopy is a way of magnifying the skin; it is not a treatment.

Cryotherapy works for hemangiomas but not for vascular malformations.

Although used formerly, this method is both dangerous and not helpful.

Both argon and dye lasers (less painful, doesn't require anesthesia) are very effective at destroying the excess vessels.

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