Pediatric Plastic and Craniofacial Surgery
The Center for Birthmarks, Cysts and Tumors at Cohen Children’s treats children and adults with tumors and growths that present at birth or later in life. Our board-certified plastic surgeons provide consultation to determine the extent of the mark. Utilizing imaging, we assess whether the mark is life-threatening. If surgery is required, meticulous technique and stealth incisions can be used to hide scars and offer the best possible outcomes.
At the Center for Birthmarks, Cysts and Tumors, we provide advanced treatment for the full range of tumors and growths, including:
Dermoid cysts are bumps around the nose, eyebrow and scalp of young children. They may grow with age and can cause inflammatory reactions or an infection when they rupture. The permanent treatment involves surgical excision of the cyst in its entirety. Cysts in the region of the nose and eye may have extension to within the skull and sometimes an MRI will be necessary to determine the depth of excision.
Treatment of a dermoid cyst is dependent on its location, but mostly involves a direct excision leaving only a thin scar. In addition, we offer stealth incisions, such as in the hairline or in the upper eyelid crease, which will camouflage any surgical scars. These cysts are usually removed at 6 months of age when elective surgery is considered optimally safe. Recovery is expedient and most parents say their child is back to normal by the following day. Swelling around the eyelid may persist for one to two weeks and will resolve spontaneously with time.
Neurofibroma is a benign tumor of the tissue that surrounds nerves. It may be associated with a syndrome known as von Recklinghausen and involves multiple parts of the body. A small percentage of these tumors can become malignant and may cause pain. Wide local excision is recommended to remove these tumors when there is a suspicion of cancer. In addition, the tumors may be thinned out to help approve the appearance and form of the affected area.
Fibrous dysplasia is a benign tumor of the bones in the face, orbit or skull, which can lead to severe disfigurement due to bone overgrowth. Our treatment is aimed at removing all involved bone and reconstructing it with bone grafts. We use 3D customized CAD/CAM technology to precisely reconstruct the involved structures based on a mirror image of the normal side.
A congenital nevus, commonly referred to as a mole or birthmark, is a nest of pigmented cells called melanocytes located underneath the skin causing a discoloration. A congenital nevus is present at birth and carries a higher rate of possible conversion to the cancer melanoma.
Treatment involves either consistent monitoring, at least on a yearly basis with your dermatologist, or a complete surgical excision by your surgeon. Most can be removed surgically leaving a thin scar. In some instances, if very large, it may be necessary to place a tissue expander balloon to stretch the normal skin to reconstruct the area after the excision, or even several excisions (serial excisions) to remove the nevus in its entirety.
When congenital nevii are large, they have a higher risk, approximately 5 to 10 percent, of malignancy. Surgery is recommended to remove the entire nevus, which often requires several operations.
A sebaceous nevus appears as a yellow or orange, smooth birthmark, often found in the scalp. They may appear patchy and without hair. These birthmarks have a risk of becoming a skin cancer (basal cell carcinoma). This condition is typically treated by surgical excision. The mark is monitored during the first few months and then can be surgically removed after the child is 6 months of age. If present on the scalp and very large, it is recommended to begin excision at 3 or 4 months of age.
A hemangioma is a benign vascular tumor that may be present at birth or appear shortly after birth. It may grow rapidly from a small pin sized red dot to a large mass (tumor) during the first few months of life. The tumors are composed of small blood vessels (capillaries) that may ulcerate causing pain or may even bleed. Most fade away to a fleshy colored fatty mass in later childhood but often require surgical excision to improve the contour of the affected area.
Medical treatment for hemangiomas may involve a medication called propranolol to induce regression in areas where surgical treatment is not optimal. Laser treatment may also be used. However, it is not optimal for thicker tumors. Initially used to treat cardiac problems, an amazing side effect of reducing the size of large hemangiomas was noted. Propranolol is now the gold standard for the treatment of complicated hemangiomas. Hospital admission for administering the drug is required for monitoring, and the results can be dramatic.
Vascular malformations are abnormal growths of arteries, veins, lymphatic vessels or capillaries. Port wine stain, a capillary malformation, may affect a significant area of the face. Capillary malformations may be more receptive to laser surgery treatment, though many laser procedures are often required to see a benefit and relapse is unfortunately common.
Arterial malformations can be very difficult to treat as recurrence is common. Surgical therapy is often combined with sclerotherapy, an injection to clot off the feeding vessels, to help shrink the malformation and possibly reduce surgical bleeding. Venous malformations are common in the lip and tongue and often require combination therapy. Lymphatic malformations may often be treated with sclerotherapy injections alone which may be sufficient to forego surgery.
Newborns may sometimes have patchy areas of the scalp missing skin or bone with exposed dural tissue, the sac covering the brain. Small defects may be treated with moist dressings but sometimes surgery is required to close the holes. This is often accomplished using tissue expanders and skin grafts.
The bone defect can sometimes fill in on its own without the need for bone grafts. When the cutis aplasia lies over the area of the large subdural veins (sinuses), special attention must be taken to ensure the tissue does not dry out.