This group of lesions are usually not seen at birth or present as a small red mole shortly after birth. The growth of these masses is variable. They may demonstrate slow progressive growth or may enlarge rapidly. They may develop anywhere on the skin including the mouth and anus. There may be other lesions in the airway lining or internal organs that may go undetected. The period of growth may last less than a month, but often occurs up to 6-9 months of age. The treatment is dictated by the location and the rate of growth. For instance, if the mass is growing on the back, a wait-and-see approach is preferred. If the mass is growing in a cosmetically sensitive area such as the lip, nose or orbit with associated obstruction or ulceration, a more aggressive approach is appropriate. This approach includes the use of high dose steroids in conjunction with ulcer prophalaxis. This medication slows down or often halts the progression or growth until the growth phase of the lesion subsides. The medication is then tapered down. The second modality of treatment is the pulse dye laser. The brand we use is the Candela Laser V-Beam. This laser emits laser energy that is adsorbed by the red in the lesion and is converted into heat energy which promotes collapse of the vessels. This treatment is used to promote involution at the skin level which may decrease the need for surgical excision or may prevent the need. The need for surgical excision is dependent on the degree of involution. About %70 of these lesions involute by age 5. This involution may be partial or complete and may require some degree of removal or scar revision. Some of these lesions are complicated by ulceration and bleeding. Some parents elect to have the lesion removed early on to avoid complications and in some patients, early surgical excision is appropriate.