October Week 3


Birthmarks – Part I. Pediatrics in Review.

Birthmarks – Part II. Pediatrics in Review.


You are sleeping soundly in the rock-hard bed at Arlington between calls on the Stork phone, and are called at 3am to investigate a funny spot on a newborn baby. The nurse says mom is concerned because there is a bald patch on baby’s head and it must be urgently addressed. On exam, you note a 2x4cm yellow-brown, warty looking oval plaque over the right parietal bone. It has a shiny, waxy appearance and there is no hair where the lesion is. You tell the mom that:
a) This lesion has the potential to become malignant, but not until adulthood
b) The lesion may become thick and papillomatous during puberty
c) Clinical follow-up is a safe alternative to prophylactic excision
d) All of the above

You are seeing a newborn boy in the nursery at Arlington and take off the diaper to find a birthmark. You tell the medical students that this is a cavernous hemangioma, which means all of the following EXCEPT:
a) It initially just looks like a patch of telangiectasias with a pale halo
b) Parents require anticipatory guidance that it will eventually turn mottled-blue and ulcerated as it gradually involutes around one year of age and complete involution by around 5 years of age
c) Under no circumstances do we treat the lesion to make it smaller
d) The incidence is about 10% in children under 1 year old

You are evaluating a 5 year old girl in CYAS and on history, there are no concerns and she has had normal growth and development, other than being 2nd percentile for height. On exam you notice several light tan macules of various shape and size, all over 1cm in diameter. You count the number of lesions and note that there are 7. What do you tell the parents about the implications of this physical finding? They ask you, “what the likelihood is that their little girl has the associated genetic condition?”
When they ask if Neurofibromatosis is the only condition associated with Café-Au-Lait Spots, you tell them, that the lesions are also associated with
a) McCune-Albright
b) Legius syndrome
c) Tuberous Sclerosis
d) All of the above

You are seeing a 12 year old boy in Adolescent Clinic. Before asking the parents to wait for the rest of the visit in the waiting room, you make sure to address mom’s questions. After she tells you that her son has 2 ingrown toe nails, will not change his socks and may have “foot fungus,” and needs something for his acne, she also mentions that one of the small brown moles on his back has developed a pale halo around it. You tell her this is called a: 
a) Garment nevus
b) Halo nevus
c) Stork bite
d) Nevus Anemicus
When she asks what we are going to do about it, you tell her:
a) I dunno. He probably needs a dermatology referral for possible excision
b) The central brown portion may completely disappear and the pallor will likely eventually return to the same pigmentation as the rest of his skin
c) The malignant potential approaches 10%

You are conducting mommy rounds at Arlington and after Dr. Reese explains “CQ” (the cuteness quotient) to a set of new parents, the mom asks about the red patch on the back of her baby’s neck. What are some of the names of this lesion? What is the etiology of this lesion? And what is the natural history of the lesion?

Case by Dr. Alsofrom