Selects: Birthmarks: Probably Not the Mark of the Devil

What It Covers

Josh Clark and Chuck Bryant cover birthmarks in a February 2020 episode, breaking down the two main categories — vascular and pigmented — explaining their medical significance, when to seek treatment, historical superstitions across cultures, and the social stigma people with visible birthmarks face today.

Key Questions Answered

• •Vascular birthmark types: Three distinct vascular birthmarks exist — macular stains (angel kisses, stork bites), port wine stains, and hemangiomas (strawberry marks). Macular stains typically fade by age two or three. Hemangiomas appear between four and six weeks after birth and usually resolve by age ten, though large ones near eyes or ears can affect vision and hearing.
• •Port wine stain warning sign: Approximately six percent of children born with port wine stain birthmarks develop Sturge-Weber Syndrome, a neurological condition. Crucially, the relationship is one-directional — every Sturge-Weber patient has a port wine stain, but most port wine stain cases do not involve the syndrome. Doctors have identified a locked-on molecular gene switch as the likely cause.
• •Cafe au lait diagnostic threshold: Six or more cafe au lait pigmented birthmarks — particularly those larger than a dime in older children — warrant a medical consultation. This pattern is associated with neurofibromatosis type one (NF1), a nerve condition. NF1 can be asymptomatic, so detection does not indicate a severe outcome, but professional evaluation is recommended.
• •Atypical moles and melanoma risk: Atypical moles displaying multiple colors, color gradients, or irregular amorphous shapes carry a documented association with melanoma. Unlike common perception, melanoma can spread rapidly through the body. Dermatologists recommend monitoring any mole showing these characteristics rather than dismissing it, as early detection significantly changes treatment outcomes.
• •Laser treatment for vascular birthmarks: Pulsed dye laser treatment targets vascular birthmarks by using a specific light wavelength that the birthmark tissue absorbs while surrounding skin does not. The absorbed light converts to heat, destroying the clustered blood vessels. Treatment works most reliably on vascular birthmarks and is most effective when started during childhood, though it involves significant discomfort.