Hemangiomas and lymphangiomas are the most common benign tumors of the skin and deeper tissues in the newborn. They represent sequestration of fetal tissue, and may be present at birth or appear in the first months after birth. Clinically classified, capillary hemangiomas include port-wine stain, strawberry hemangioma and salmon patch. Other clinical classifications of hemangiomas are capillary/cavernous, cavernous, and verrucous, keratotic or venous.
Vascular malformations also include lymphangiomas, lymphangiohemangiomas, arteriovenous malformations and vascular gigantism.

These benign tumors of the skin range in size and appearance from very small and negligibly disfiguring to very large and overwhelmingly disfiguring. Some cellularly dynamic hemangiomas such as the so-called strawberry lesion may regress and disappear during the first weeks or months of the infant's life. Large, critically located hemangiomas and lymphangiomas can be life-threatening as well as substantially disfiguring. Multiple hemangiomas of the newborn with diffuse involvement of the skin, liver, and intestinal tract pose a significant mortality risk.
Arteriovenous malformations: Arteriovenous malformations are defects of the circulatory system that are generally believed to arise during embryonic or fetal development or soon after birth. Although AVMs can develop in many different sites, those located in the brain or spinal cord can have especially widespread effects on the body. Most people with neurological AVMs experience few, if any, significant symptoms. The malformations tend to be discovered only incidentally, usually either at autopsy or during treatment for an unrelated disorder. But for about 12 percent of the affected population (about 36,000 of the estimated 300,000 Americans with AVMs), these abnormalities cause symptoms that vary greatly in severity.

Hemangiomas: A hemangioma is an abnormal buildup of blood vessels in the skin or internal organs. The hemangioma may occur in the top skin layers (capillary hemangioma), deeper in the skin (cavernous hemangioma), a combination of both. Hemangiomas of infancy are benign (non-cancerous) vascular tumors composed of cells that normally line the blood vessels (endothelial cells). They are the most common tumor of childhood, occurring in up to 10% of infants. Hemangiomas are seen in all racial groups but are more common in Caucasians. They also occur more frequently in girls and low-birth-weight (less than 1,000 grams) premature infants.
Hemangiomas of infancy may be visible at birth or may not be recognized until the first few weeks or even months of life. In general, however, most hemangiomas become evident by 2 to 3 weeks of age. Although they commonly occur on the head or neck (60%), they can occur in any region of the body. Some lesions are small and hardly visible, whereas others are large and readily observable. Most hemangiomas appear as single tumors, though 15% present with more than one lesion.
Hemangiomas are classified as superficial, deep, or combined, depending upon the involvement of the skin and other soft tissues. If the lesion is near the skin surface, it is referred to as a superficial hemangioma. If it grows in the lower layers of the skin or in muscle, it is called a deep lesion. When it has components of both superficial and deep lesions, we refer to it as a combined lesion. Superficial lesions appear as bright red, raised or flat patches on the skin or a textured area that resembles the appearance of a strawberry. Veins radiating from the lesion also may be visible beneath the skin. Deep hemangiomas have a gray to blue hue, but due to their depth they may not be noticed for many weeks or months after birth, although they are growing. This type of lesion is firmer and more rubbery to touch, and its color does not completely disappear when you press on the area. Combined lesions may have a layered combination of red on top and blue below. As hemangiomas involute, they undergo a change in consistency and color, becoming softer and grayer. Eventually, the lesion is replaced internally by fatty tissue. The more visible involved skin is replaced by thin skin that appears more normal.
The cause of hemangiomas is not yet understood, but it is known that they are not related to drugs or medications that may have been taken during pregnancy, nor are they related to any known environmental exposures that may have occurred during that time. Although no specific gene abnormality has been identified, in some families multiple family members over several generations have been affected.
Klippel-Trenaunay Syndrome: Varied in its presentation but is classically described as an enlarged extremity on one side of the body with an overlying port-wine stain. Classically there is an underlying vascular tumor comprised of veins or lymphatic vessels. Excessive bone growth in the involved limbs may occur as well.

Lymphangiomas: Lymphangiomas (lymphatic malformations) are skin bumps caused by a collection of enlarged lymph vessels-the channels that carry lymph (a clear fluid related to blood) throughout the body. Lymphangiomas are uncommon but usually appear between birth and age 2. They may be tiny bumps or large, deforming growths. Lymphangiomas do not itch or hurt and are not a form of cancer. Most lymphangiomas are yellowish tan, but a few are reddish. When injured or punctured, they release a colorless fluid. Treatment is not usually needed. Removal by surgery is usually not successful since lymphangiomas grow deep and wide beneath the surface.

Port-Wine Stain: A capillary malformation (commonly referred to as a port-wine stain), is a flat, sharply defined vascular stain of the skin. It may cover a large surface area or it may be scattered and appear as little islands of color. It can be anywhere on the body and in more than one place on the body, but is most commonly seen in the head/neck region. The exact cause of this lesion is not known, but it is thought that it arises because of abnormal formation of the tiny blood vessels of the skin early in the life of the embryo, after the larger blood vessels are in place. Capillary malformations are unrelated to drugs or medications that may have been taken during pregnancy or to environmental exposures that may have occurred at that time.
Although the number of blood vessels in a capillary malformation is normal, the diameter of the affected vessels is much larger than that in normal vessels; this enlargement results in increased blood flow. Because the vessels are close to the surface, this increased flow gives the skin its pink to purple appearance. As your child grows, the affected blood vessels will continue to enlarge and thicken, causing the color of the lesion to darken. Over time, the clusters of tiny, dilated venules (small vessels that collect blood from the capillary junctions and join to form veins) give a lumpy appearance to the skin. The period of time over which this progression occurs varies greatly from person to person, and may even be delayed until ages 40, 50, or 60.

Capillary malformations on the forehead and upper eyelid can be associated with lesions of the brain and eye (Sturge-Weber syndrome).Capillary malformations also can overlie other vascular lesions such as lymphatic malformations, venous malformations, or arteriovenous malformations.

Some commonly seen birthmarks in fair-skinned infants are capillary malformations. When these birthmarks appear on the forehead, eyelids, nose, or upper lip, they are often referred to as "angel kisses." When located on the base of the neck, they are often referred to as "stork bites."

Sturge-Weber syndrome: Sturge-Weber syndrome is a rare congenital (present at birth) condition of unknown origin. A portwine stain (capillary malformation) on the face and often the eyelids may signal the presence of this syndrome; however, not all infants with a facial capillary malformation have this syndrome. Variation in the size of the facial lesion is common, and one or both sides of the face may be involved.
The mucous membranes (lining of the mouth and nose) and the meninges (covering of the brain) also can be affected.Because brain involvement is variable, symptoms differ from person to person. Some patients have no symptoms, whereas others may develop visual problems, seizures, or weakness or paralysis on one side. Learning disabilities ranging from mild to severe, as well as mental retardation, also are seen.
When a child has an extensive capillary malformation (portwine stain) that involves the skin on the eyelids, diagnostic tests should be performed. An MRI determines if there is brain involvement. An eye examination determines if glaucoma (increased pressure of the fluid within the eye) is present.
Venous malformations: Venous malformations comprise either superficial or deep veins that are abnormally formed and dilated. The walls of these vessels are thin because they lack smooth muscle. They are the most common type of vascular malformation. Although they usually are present at birth, they may not be seen until years later. The natural history of a venous malformation is slow, steady enlargement. However, events such as surgery, trauma, infection, or hormonal changes associated with puberty, pregnancy, or menopause may cause rapid expansion. These lesions may be present in the skin, mucous membrane or in any organ system including the brain, bowel, liver, or spleen.
Although the exact cause of these lesions has not yet been determined, a deficiency of smooth muscle cells in the vein walls is known to be a critical factor. Neither drugs nor medications that may have been taken during pregnancy nor environmental exposures that may have occurred during that time could have caused a venous malformation. There have been some families identified with multiple venous malformations that have alterations in the genes responsible for the communication of endothelial cells and smooth muscle.
Venous malformations can be superficial or deep or can have both superficial and deep components. They can also be localized or diffuse and can occur in more than one site. Their color depends upon the depth and amount of expansion in the affected vessels. The closer these vessels are to the surface, the deeper the color. A superficial lesion thus tends to be maroonish-red, whereas a deep lesion may show a bluish hue. A very deep lesion may have no color, but just reveal itself as a protruding mass. Venous malformations are soft to touch. When they are compressed, the color changes as the blood empties out. When your child cries or is lying down, the lesion expands, the blood vessels fill, and the color becomes more intense.

Some other conditions Share A Smile ^{TM ®} has provided treatment for:

Brachycephaly: Deformational brachycephaly is present when the entire back of the baby's head is flat (central flattening) and the head is very wide. The forehead is often bossed or prominent on both sides, and the height of the head is excessively high. In our experience, deformational brachycephaly without asymmetry accounts for about 1 in 10 of the children referred for treatment. Often babies with this problem have a history of excessive time in carriers, possibly due to gastric reflux or other medical condition or circumstance that does not allow the baby to be placed on the tummy during daytime hours while awake and supervised.

Craniosynostosis: Craniosynostosis is a birth defect of the brain characterized by the premature closure of one or more of the fibrous joints between the bones of the skull (called the cranial sutures) before brain growth is complete. Closure of a single suture is most common. In contrast to normal skull growth, in which the skull expands uniformly to accommodate the growth of the brain, premature closure of a single suture restricts the growth in that part of the skull and promotes growth in other parts of the skull where sutures remain open. This results in an abnormal shape of the skull, but does not prevent the brain from expanding to a normal volume. However, when many sutures close prematurely, the skull cannot expand to accommodate the growing brain, which leads to increased pressure within the skull and impaired development of the brain. Craniosynostosis can be gene-linked, or caused by metabolic diseases, such as rickets or an overactive thyroid. Some cases are associated with other disorders such as microcephaly (abnormally small head) and hydrocephalus (excessive accumulation of cerebrospinal fluid in the brain). The first sign of craniosynostosis is an abnormally shaped skull. Other features can include signs of increased intracranial pressure, developmental delays, or mental retardation, which are caused by constriction of the growing brain. Seizures and blindness may also occur.

Plagiocephaly: Deformational Plagiocephaly (also commonly referred to as "flat head syndrome") is the abnormal shape of a baby's head caused by external forces. It is estimated that 1 in 5 babies have some degree of head shape asymmetry, or plagiocephaly. Plagiocephaly can be the result of a baby's in utero positioning, torticollis (tightening of the neck muscle), or even prolonged periods of time spent on their backs while sleeping and in carriers. The baby's head may appear to be misshapen or asymmetrical immediately after birth, or the abnormal shape may become noticeable in the first few months of life. Parents, grandparents, and caregivers are often the first ones to notice the unusual shape of the head, and they bring it to the pediatrician's attention.

Scaphocephaly: Deformational scaphocephaly is characterized by a long and narrow head shape, sometimes caused by consistent positioning of the baby on its side. Like brachycephaly, scaphocephaly is a deformity of proportion. Premature babies are particularly prone to this deformity since their skulls are so fragile, and a side-lying position is often used in the Neonatal Intensive Care Unit (NICU) for easy access to monitors and other equipment.

Torticollis: Torticollis is usually caused by an imbalance in the sternocleidomastoid and other neck muscles, which prevents full range of motion in the neck. It is estimated that about 85% of the babies with deformational plagiocephaly also have some level of torticollis. Typically, the head of a baby with torticollis is slightly tipped to one side and rotated to the opposite shoulder, causing the head to consistently rest in the same position. The constant positioning of the head to the same side causes it to become flat in the back. Torticollis can also pull abnormally on the base of the skull and cause the ear on the same side as the posterior flattening to be pushed more forward than the opposite ear. In severe cases, the forehead can also be pushed forward on the same side, and the facial features including the eyes, cheeks, and jaw may not be symmetrical.

Renée Rosen knows this heartache personally as she was born with a hemangioma. While her condition was never as severe as Nina’s (the young girl in the book), Rosen did undergo experimental sclerosing agent injections and was treated with Argon and C02 lasers back in the 1970s. When asked what prompted her to write this novel, Rosen said, “This was the book I needed to read when I was growing up. I needed to see that I was not alone, that underneath it all, I was still lovable and that I would find a way to be happy, birthmark and all.”

Renee very generously donated several copies of her brand new novel to Share A Smile ^{TM ®} for use in our exciting raffle off at the 2007 polo match fundraiser!