Nevus Simplex (Salmon Patch)

Topic Name Introduction Clinical Features Anatomical Variants Differential Diagnosis Natural History Management Special Considerations

Nevus Simplex (Salmon Patch)

Nevus simplex, also known as salmon patch, stork bite, or angel kiss, is a common congenital capillary malformation present in up to 80% of newborns. These lesions represent dilated dermal capillaries and are typically found in characteristic locations.

Key Points

• Prevalence: 40-80% of newborns
• Etiology: Persistent fetal dermal vessels
• Inheritance: Sporadic occurrence
• Common locations: Nape of neck, glabella, eyelids, nose
• Nature: Benign vascular lesion

Morphological Characteristics

• Visual Appearance:
  • Pink to red macules
  • Poorly defined borders
  • Blanches with pressure
  • Symmetric distribution
  • May become more prominent with crying or temperature changes
• Physical Properties:
  • Flat to surface
  • Non-palpable
  • No surface changes
  • Variable size (few mm to several cm)
  • May be confluent or patchy

Color Variations

• Spectrum:
  • Light pink in fair skin
  • Deeper pink to red in medium skin tones
  • Purplish in darker skin tones
  • Color intensity varies with activity

Location-Specific Features

• Nuchal Region ("Stork Bite"):
  • Most common location (35-40%)
  • Usually persists into adulthood
  • Often hidden by hair
  • May extend to scalp or upper back
• Facial Region ("Angel Kiss"):
  • Glabella (between eyebrows)
  • Upper eyelids
  • Nasal bridge
  • Upper lip
  • Usually fades by age 1-2 years
• Other Sites:
  • Central forehead
  • Temple region
  • Occipital area
  • Rarely on trunk or extremities

Distribution Patterns

• Single vs Multiple:
  • Can occur as isolated lesions
  • Multiple lesions in 20-30%
  • Often bilateral when facial
  • May be segmental in distribution

Common Differentials

• Vascular Lesions:
  • Port-wine stain
    • Darker red/purple color
    • Well-defined borders
    • Progressive darkening
    • Does not fade
  • Infantile hemangioma
    • Proliferative phase
    • Raised surface
    • Progressive growth
    • Later onset
• Other Conditions:
  • Telangiectasias
  • Cutis marmorata
  • Spider angiomas
  • PHACE syndrome (when extensive)

Key Distinguishing Features

• Diagnostic Clues:
  • Present at birth
  • Characteristic locations
  • Complete blanching
  • Symmetrical distribution
  • No associated symptoms

Evolution Over Time

• Facial Lesions:
  • Peak prominence at birth
  • Gradual fading over months
  • 80-90% resolution by age 2
  • May be visible with crying/fever
• Nuchal Lesions:
  • Usually persistent
  • May become less noticeable
  • Often covered by hair
  • Can darken with emotion/temperature

Prognostic Factors

• Favorable Indicators:
  • Facial location
  • Smaller size
  • Light pink color
  • Single lesion
• Persistence Factors:
  • Nuchal location
  • Darker color
  • Multiple lesions
  • Family history

Clinical Approach

• Initial Assessment:
  • Document location and extent
  • Photograph if possible
  • Assess for associated findings
  • Record family history
• Monitoring:
  • Regular follow-up at well-child visits
  • Track natural evolution
  • Document changes
  • Assess parent concerns

Treatment Options

• Conservative Management:
  • Observation
  • Reassurance
  • Photography documentation
  • Regular monitoring
• Interventional Options:
  • Rarely indicated
  • Laser therapy for persistent cases
  • Cosmetic camouflage if desired
  • Reserved for older children/adults

Parent Education

• Counseling Points:
  • Natural history
  • Benign nature
  • Expected timeline for resolution
  • Triggers for prominence
  • When to seek medical attention
• Documentation Needs:
  • Baseline photographs
  • Growth pattern
  • Color changes
  • Associated features

Research Updates

• Recent Findings:
  • Genetic associations
  • Vascular development patterns
  • Treatment modalities
  • Long-term outcomes
• Clinical Implications:
  • Improved prognostic information
  • Better treatment selection
  • Enhanced monitoring protocols
  • Updated parent counseling

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.