Question:

A two and a half year-old girl developed a bright red vascular lesion on her right face that first appeared several weeks after birth. The lesion grew rapidly in size for several months, then became stationary for one year and recently became pale in colour with some involution. There was no ulceration or bleeding.

Answer: C. Capillary haemangioma

Capillary haemangioma, also known as strawberry naevus, develops as a bright red swelling several weeks after birth. They enlarge rapidly to reach a maximum size by 6-12 months. Thereafter the surface becomes grey and the lesion shrinks spontaneously. Fifty percent show complete regression by the fifth birthday, and 70% completely regress by the seventh birthday. Deeper lesions, known as cavernous haemangiomata, are bluish subcutaneous swellings often with a superficial strawberry component. The deeper areas often fail to regress completely. Complications include ulceration, bleeding, thrombocytopenia, and large lesions around orifices may obstruct the airway, interfere with feeding or development of binocular vision. The majority of strawberry naevi resolve without therapy. Complicated lesions have been treated with systemic steroids, interferon, plastic surgery, laser therapy and pressure garments.

Salmon patch is a common telangiectatic naevus seen at birth, comprising a pink or red patch of dilated vessels affecting the forehead, eyelids or upper lips, and nape of neck. With time the lesions on the face fade, but the nuchal lesions still persist in adults. Portwine stain is a vascular birthmark presenting as a unilateral red patch, usually affecting the face. It is present at birth, but thickens and darkens with age. Meningeal involvement with epilepsy occurs in Sturge-Weber Syndrome.