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Vascular Skin Lesions: When Should You Be Concerned?

Vascular lesions are not always harmful; birthmarks, for instance, are a type of vascular lesion.

Learn when vascular lesions should be a cause for concern from Dr. Barrett Zlotoff, a UVA dermatologist who specializes in these lesions.
Vascular Skin Lesions: When Should You Be Concerned?
Featured Speaker:
Barrett J. Zlotoff, MD
Dr. Barrett Zlotoff is board certified in dermatology and pediatric dermatology; his specialties include pediatric dermatology and treating vascular lesions.

Learn more about Dr. Barrett Zlotoff

Learn more about UVA Dermatology

Melanie Cole (Host):  Vascular lesions are not always harmful.  Birthmarks, for instance, are a type of vascular lesion but when should you be concerned?  My guest today is Dr. Barrett Zlotoff.  He’s board certified in dermatology and pediatric dermatology at UVA Health Systems.  Welcome to the show, Dr. Zlotoff.  First, explain what vascular lesions of the skin are.

Dr. Barrett Zlotoff (Guest):  Like you mentioned, vascular lesions are birthmarks that are made of blood vessels.  There are many different types and that’s one of the things I find so interesting about vascular lesions.  They can be made of small blood vessels called “capillaries” and they are called a “hemangioma”.  If you have collections of veins, you can have venous malformations.  If you have collections of lymphatics, you can have a lymphatic malformation.  You can have port wine stains, arterial venous malformations and you can have various combinations of all of these types of blood vessels to make different sort of vascular lesions.

Melanie:  First of all, if a child has one of these lesions is--it automatically a cause for concern?  When do they run in and see a doctor?

Dr. Zlotoff:  No. There are many vascular lesions that are just birthmarks that have no worrisome associations and don’t cause any problems.  Some infantile hemangiomas can even go away on their own with no treatment and get better by themselves.  I think that most vascular lesions should at least be discussed with your pediatrician at “well child” visits and the pediatrician can help you determine if the lesion could cause problems.  Some of the issues occur when vascular lesions are near the eyes, around the mouth, on a central face or places where vascular lesions can cause issues with vision, feeding, breathing or cause disfiguring changes in the face or other areas.  When vascular lesions are bleeding or have sores in them or ulcers are forming, we should also evaluate them as soon as possible or if they are growing really rapidly.

Melanie:  Birthmarks was one of the first things that we mentioned and those can be anywhere on a child.  If they are on their temple or anywhere around that, does a parent keep an eye on those?  How does that work?

Dr. Zlotoff:  I think we can definitely keep an eye on them but there are things that can be associated with different birthmarks.  Birthmark, as the name suggests, can be a marker to suggest other things.  So it’s really important that all kids who have birthmarks just at least have them looked at by their pediatrician in their “well child” visits and discuss them and get an idea if there should be any concern or not.

Melanie:  When does somebody take their child to the doctor to have something done?  What kinds of vascular lesions do you like to treat?

Dr. Zlotoff:  We treat a lot of infantile hemangiomas, which are kind of the strawberry hemangiomas that are the most common vascular lesions that we see.  They are so common that we see them in about 5% of kids.  They are a normal thing and many kids have them.  There are great new treatments for these hemangiomas. Oftentimes, we see them on the face or areas where they’re going to cause problems in the future or they could stretch out the skin and cause difficulties later on down the line; so then, we will treat them.

Melanie:  What kind of treatments are available?  What do you do for them?

Dr. Zlotoff:  Well, this is an exciting time for vascular lesions in general and hemangiomas in particular.  There are a lot of recent advances in treatment for vascular lesions that are super exciting.  There are new medications. Propranolol is one of the ones that’s been in the news lately.  Propranolol is a blood pressure medicine that was recently accidentally discovered in France to shrink hemangiomas down when they gave to a kid when they had high blood pressure they noticed that all their hemangiomas kind of melted away.  So, we’re doing exciting things with some medications like propranolol and erythromycin.  There are new ways to do sclerotherapy where medicines can actually be injected into vascular lesions to shrink them down.   There are surgical techniques to remove many types of vascular lesions and there are a lot of new lasers out, too, a few of which we have here at UVA that can treat vascular lesions, even like port wine stains that can very easily be lasered now.

Melanie:  Working with children with these things is there any plastic surgery involved?  Is there any worry from parents about leaving scars?

Dr. Zlotoff:  We work very closely with pediatric plastic surgery and plastic surgeons in general in our multi-disciplinary vascular lesions clinic and some of these lesions do require some surgery.  The plastic surgeons are very good at minimizing surgical scars.  A lot of times, our goal is to get at these lesions as early as possible and as early an age as possible so that we can prevent scars and we can prevent disfiguring surgeries down the line which is why I think it’s so important that they be evaluated at an early age.

Melanie:  So, even when they’re little babies, that’s an okay time to look at these?  You don’t wait and watch them and see if they grow with the baby?

Dr. Zlotoff:  No, I think that’s the best time to get on top of them and really see what we’re dealing with so we can come up with a treatment plan.  Sometimes, the plan will be do nothing and just watch the lesion but if you make that decision early, you have a lot more options for treatment and you may not be doing the treatment right away but you will at least know the treatment plan.

Melanie:   Are there any, Dr. Zlotoff, that are cause for concern that you say, “We have to treat this because there could be complications”?

Dr. Zlotoff:  The big ones are vascular lesions that are going to cause functional issues.  So, we see vascular lesions on the tongue sometimes; we see them in the throat, in the neck, in areas that are going to push on the larynx or the breathing tube and cause issues with breathing.  We see vascular lesions that are near the eyes that can cause issues with vision and that’s a big one for kids.  If the eyes are in any way blocked for even a few weeks in a developing child, you can have lifelong issues with vision and blindness.  So, we’re really aggressive about treating those types of lesions that are causing functional issues.

Melanie:  In just the last few minutes, Dr. Zlotoff, when should patients and why should patients get their dermatology care at UVA Health Systems?

Dr. Zlotoff:  I think the great thing about UVA is the number of specialists that we have that can address vascular lesions in so many different ways.  We have so many tools at our disposal and now we have just started up a new multi-disciplinary vascular lesions clinic.  It’s a multispecialty interdisciplinary team that works together so it includes dermatologists, radiologists, interventional radiologists, surgeons, hematologists, oncologists, ear nose and throat doctors and a variety of other specialists that all meet together to discuss complicated cases and vascular lesion cases.  So, we can all work together, we literally all sit in the same room, look at the imaging together and say, “How are we going to approach this case?  Maybe this case could do better with surgery; maybe it could be a good combination of sclerotherapy and surgery.   Maybe we could do a little laser first and then supplement that with surgery later.”  But, the plan of care is discussed together by all the providers and this is a really innovative approach and, I think, a special way to do it so that a patient doesn’t have to see ten different providers and the providers can actually communicate face to face to really come up with a plan together and I think that’s a really unusual and valuable service that UVA provides.

Melanie:  Wow.  That’s incredible.  I applaud all the great work that you’re doing and thank you so much for being with us.  You’re listening to UVA Health Systems Radio.  For more information on dermatology at UVA you can go to  That’s  This is Melanie Cole.  Thanks so much for listening.