Advice regarding a birthmark ('strawberry naevus')

[Morecambe]

Good day from England.  My daughter gave birth to twin girls three months ago and over this period of time one of the babies has gradually developed a small growth which has been referred to as a "strawberry naevus".  The colour is an intense pink/red and the growth is situated about 5 mm below the top of the lower right eyelid/eyelashes at a position directly below the centre of the eye (i.e. perpentidularly below the pupil).  The texture of the growth is "spongy-looking" and it measures about 3mm x 3mm.  It is a raised growth - i.e. not "flush" with the surface of the skin.  All that my daughter has been able to learn is that these growths/marks often disappear after 5-7 years by themselves.  However, whereas that may be true, my daughter would like to know whether there is any treatment that can be offered at an earlier stage.  Of course she will have to consider whether the invasiveness/discomfort of the treatment is preferable to the inevitable self-conciousness and staring/
taunting/interrogation that her daughter may suffer in a few years from other inquisitive children...

Please could I pose to you the following questions:-

a) what treatment(s) can be suggested?  
b) How long to they take to perform?  Any pain/scars/after-effects?
c) is there an optimum age for such treatments on very young children?
d) is the position of the growth on the lower eyelid suitable for treatment on a risk-free basis?
e) What are the merits and advantages/disadvantages of the treatments?
f) what do you think about the above dilemma of early treatment (to save embarrassment) versus allowing the growth to fade?
g) if treatment is not performed, is there a risk that the growth area/volume will increase resulting in a more radical regime of treatment later?
h) is there an increased risk that the other twin baby might subsequently develop a similar growth?
i) any other thoughts/suggestions most gratefully received.

Many thanks in anticipation of your kind comments.

[Alan Rockoff, MD]

So-called strawberry marks do indeed most often fade over 5-7 years.  Nevertheless, when they are on a sensitive area like the face, treating them earlier is not unreasonable to consider.  The treatment most often used nowadays is laser therapy.  A variety of lasers can help, including the pulsed-dye laser.  These are quite safe and noninvasive, even in infants, as they were in fact developed to treat newborn birthmarks.  My advice is to consult a laser specialist affiliated with a children's medical facility.  Such a specialist will have the requisite experience dealing with facial marks in children, and will be able to answer all your questions in detail, so you can make an informed choice.

Best.

Dr. Rockoff