Port-Wine Stain Versus Salmon Patch: How to Tell the Difference

Sometimes, it is virtually impossible to differentiate between a port-wine stain and a salmon patch clinically, which is very critical for management. Any comment?
—— Ronjon Bhattacharyya

Port-wine stains (also known as nevus flammeus) and salmon patches (also known as nevus simplex) have distinctive clinical features that usually allow a straightforward diagnosis.

Port-wine stains are relatively uncommon, occurring in about 0.3% of all neonates. On the other hand, salmon patches are common and present in about 44% of all neonates.^1,2

Port-wine stains usually present at birth as sharply demarcated red macules or patches (Figure 1). The lesions often become dark red during adolescence and violaceous with advancing age. The term “port-wine stain” is derived from the purplish red color of the lesions. Although the lesions are initially macular, the surface might become irregular, thickened, and nodular over time.³ Port-wine stains can occur anywhere on the body; however, the most common site is the face. The lesions are usually unilateral and segmental³; they grow with the child and persist throughout life. Although usually an isolated finding, port-wine stain is also a typical feature of Sturge-Weber syndrome and Klippel-Trenaunay syndrome.

Salmon patches are scarlet to pink and flat, can be totally blanched, and usually deepen in color with vigorous activity (crying, straining with defecation, breathholding) or with changes in ambient temperature.⁴ The lesions are most commonly found on the nape, followed by the glabella and eyelids (Figure 2). Colloquially, the lesions on the forehead and eyelids are known as “angel’s kisses” and the ones in the occipital area as “stork beak marks” or “stork bite marks.”¹ Other, less common sites are the nasolabial folds, lips, and sacral area. Salmon patches are usually symmetrical, with lesions on both eyelids or on both sides of midline.⁵ Most lesions are sporadic and occur as an isolated finding. Prominent lesions in the glabella are associated with Beckwith-Wiedemann syndrome, fetal alcohol syndrome, and Nova syndrome.¹ In spite of their midline location, most salmon patches, except those in the sacral area, are not associated with spinal dysraphism. Salmon patches tend to resolve or significantly regress with time.⁴ Those on the eyelids and glabella usually disappear by 2 to 3 years of age.² Nuchal and sacral lesions tend to persist longer. Salmon patches are rarely detected after age 6 years.²

Alexander K. C. Leung, MD, is a Clinical Professor of Pediatrics at the University of Calgary and a Pediatric Consultant at Alberta Children’s Hospital.