Skin Diseases of Children/Vascular Naevus

by George Henry Fox

PLATE IX.

Vascular Naevus.

From the collection of photographs of Dr. George Henry Fox

VASCULAR NAEVUS.

The vascular form of neevus results from an excessive development of vascular tissue in or beneath the skin, and presents a variety of clinical appearances. These may be conveniently classified as follows : 1, nsevus araneus ; 2, nsevus flammeus, or port-wine mark ; 3, naevus tuberosus ; and 4, nsevus cavernosus. Of the many descriptive names which have been more or less in use, these appear to best express the characteristic features of the four clinical varieties of vascular nsevus.

Naevus araneus consists of a small red spot, smooth or slightly elevated, from which several dilated capillaries radiate like the legs of a spider. It has sometimes been called " spider cancer,"' a name which is as alarming as it is inappropriate. It is not always congenital, but frequently appears in youth or adult life as the result of a prick, bruise, or other injury to the skin. On this account some writers class it under the head of telangiectasis or acquired vascular dilatation, assuming that the term nsevus signifies a birthmark and not merely a spot or blemish. It is most frequently noted upon the upper portion of the face, and upon a fair white skin may be quite conspicuous and annoying.

Naevus flammeus, birthmark or port-wine mark, as it is commonly called, usually appears as a smooth, red discoloration upon one side of the face. It varies greatly in size, often ex- tending down upon the neck and involving a considerable portion of the trunk. It varies also in color from a light pink to a deep purplish-red or even slate-colored hue. In its severe form the affected skin is elevated, the lip greatly swollen, and one side of the face may appear notably larger than the other. The dark surface of the skin may be dotted here and there in some cases by small vascular excrescences. At birth small, faint red marks may be noted, especially upon the lower portion of the occiput, which tend to disappear in later years, but the port-wine mark usually persists throughout life, either remaining unchanged or becoming more conspicuous. It has been claimed that some cases have increased in area and that others have gradually disappeared, leaving atrophic scars, but such cases are notable exceptions to the rule.

Nævus tuberosus is a turgescent tumor of varying size with a rounded or flattened surface. It results from a congenital dilatation or new formation of blood vessels, and in color varies from a bright cherry-red to a purplish-red or leaden hue, according to the predominance of arterial or venous blood in the

Fig 31.—Nævus of nose.

tumor. It is frequently seen upon the scalp and face, although it may be found upon the trunk and extremities. It usually increases somewhat in size during the early months of infancy, and in some cases develops with such alarming rapidity that vigorous treatment is called for without delay. The tumor is usually elastic and compressible, and often varies in size and color at different times of day, and is especially prominent after a fit of crying or severe coughing. A distinct pulsation may be sometimes felt, corresponding in rhythm with the action of the heart. Ulceration of the central portion of the surface occasionally takes place, and from this cause or from some accidental injury severe hemorrhage may result. Gangrene may occur and produce a spontaneous cure.

Nævus cavernosus is a deep-seated form of angioma over which the raised skin may appear of normal hue or present a dull-bluish or venous appearance. The tumor is formed by

Fig. 33.—Birthmark of unusual extent.

masses of dilated veins and arteries surrounded by firm connective tissue, which extends into the interior and forms vascular cavities communicating freely with the enlarged vessels. In some cases a number of these tumors, of varying size but of the same character, will extend along the surface of the skin like deep varices. They are usually soft, especially when of large size, and have a peculiar lobulated feeling when pressed beneath the fingers.

In the treatment of nævus araneus and other telangiectases the electrolytic needle is most serviceable. Any form of galvanic battery may be used, and the point of an ordinary cambric needle or flexible steel jeweller's broach, attached to the negative cord, should be pressed into the centre of the red spot. A moist sponge attached to the positive cord should now be grasped in the patient's hand or slowly applied to the skin at any point, when the electrolytic current will begin to act and quickly produce a whitening of the skin around the needle

Fig. 33.—Nævus of scalp.

point and cause sufficient inflammation to seal up the deep-seated supply vessel. The pain caused by this operation is slight and no more than the promise of some candy or a coveted toy will induce the average child to endure. The result is always excellent.

The electrolytic needle may also be used with success in many cases of port-wine mark, but the treatment is tedious and only capable of producing good results when persistently and skilfully employed. The best that can be said of it is that in case of extensive and dark-hued patches it is superior to any other plan of treatment, even if it is not productive of the speedy and brilliant result which might be desired. The object of this method of treatment is to cover the dark-red skin with minute punctate cicatrices, which will at least lessen the conspicuous character of the mark, if it does not remove it entirely. To remove a red birthmark and leave a perfectly normal skin is an impossibility. In cases where the color is not

Fig. 34.—Nævus tuberosus.

very deep a good result may be obtained by dotting the surface with minute drops of nitric acid, great care being taken that these do not spread or run together and in this way produce ulceration and subsequent pitted or raised cicatrices.

In the tuberose variety of nævus, where red tumors suggestive of a strawberry, cherry, or flattened tomato are to be removed, a resulting cicatrix is unavoidable, and either acids, electrolysis, or the platinum cautery may be advantageously used. The size and disfiguring character of the scar which is necessarily produced will depend in great measure, however, upon the skill and caution displayed in the treatment, whatever means may be employed in destroying the vascular growth. The attempt to remove this form of nævus by compression has always failed, in my experience; and as for ethylate of sodium,

Fig. 35.—Nævus of vulva.

although it has proved successful, it has been quite as painful and less effective than nitric acid.

In the treatment of the cavernous nævus the knife, ligature, galvano-cautery, and injections of carbolic acid and of iodine have been recommended, and the most suitable method of treatment must depend upon the nature of the case.