What is the term for a minor skin lesion abnormality in a newborn, also known as a congenital skin lesion or birthmark?

Terminology for Minor Skin Lesion Abnormalities in Newborns

The general term for a minor skin lesion abnormality in a newborn is "birthmark," which encompasses both vascular anomalies (such as infantile hemangiomas, capillary malformations, nevus simplex, and port wine stains) and pigmented lesions (such as congenital melanocytic nevi, café-au-lait macules, and Mongolian spots). 1, 2

Classification Framework

The American Academy of Pediatrics recognizes two major categories of birthmarks in newborns 1:

Vascular Anomalies

These are further subdivided into:

• Vascular tumors (benign neoplasms with abnormal proliferation of endothelial cells):

  • Infantile hemangioma (IH) - the most common vascular neoplasm, affecting up to 5% of infants 1
  • Congenital hemangiomas (RICH and NICH) - present and fully formed at birth, unlike IH 1
  • Pyogenic granuloma (lobular capillary hemangioma) - a reactive proliferating lesion 1

• Vascular malformations (structural anomalies and inborn errors of vascular morphogenesis):

  • Capillary malformations, including nevus simplex (also called "salmon patch," "angel kiss," or "stork bite") - present in up to 43% of the general population 1
  • Port wine stains (nevus flammeus) - darker red-purple flat lesions with well-defined borders 1
  • Venous, lymphatic, arterial, or mixed malformations 1

Pigmented Lesions

• Congenital melanocytic nevi (CMN) - collections of melanocytes in the skin with incidence ranging from <1% to 3.6% 1
• Mongolian spots (dermal melanocytosis) - benign findings seen in 84.7% of newborns in some populations 3, 2
• Café-au-lait macules - present in approximately 1.3% of newborns 3

Important Clinical Distinctions

Terminology Evolution

The medical community has moved away from older, confusing terminology (such as "strawberry birthmark," "cavernous hemangioma") to classification based on cellular features, natural history, and clinical behavior, as established by the International Society for the Study of Vascular Anomalies 1.

Common Pitfalls to Avoid

• Do not use "hemangioma" without the descriptor "infantile" - this creates diagnostic confusion with other vascular lesions 1
• "Cavernous hemangiomas" are usually deep infantile hemangiomas or venous malformations, not a distinct entity 1
• Distinguish raised infantile hemangiomas from flat capillary malformations - this distinction is critical for management 1

Risk Stratification for Clinical Significance

The American Academy of Pediatrics categorizes cutaneous markers by risk level 1:

High-Risk Markers (requiring imaging and specialist referral):

• Midline infantile hemangiomas overlying the spine 1
• Hypertrichosis (focal hair tuft) 1
• Large or giant congenital melanocytic nevi 1, 4
• Multiple congenital melanocytic nevi 1, 4

Intermediate-Risk Markers:

• Midline capillary malformations over the lumbosacral spine 1
• Mongolian spots in certain locations 1

Low-Risk Markers (benign, requiring no intervention):

• Isolated café-au-lait spots 1
• Nonmidline capillary malformations on the glabella, lip, or nape of neck 1
• Simple coccygeal dimples 1

Physiological vs. Pathological Lesions

Physiological skin changes (transient, self-limited, requiring no therapy) include sebaceous gland hyperplasia (89.4%), Epstein pearls (89.1%), and physiological scaling (10.8%) 3. These should be distinguished from true birthmarks to avoid unnecessary interventions 3.