A 20-day-old boy with a blue skin lesion. Noninvoluting congenital hemangioma

A 20-day-old boy presented for evaluation of a blue nodule on the right shoulder that had been present since birth. The mother noted no changes in the size of the lesion since birth, and no bleeding or ulceration was noted. The patient's past medical history was unremarkable. He was a full-term baby born at 39 weeks gestation via a normal, spontaneous vaginal delivery. The pregnancy was uncomplicated. The mother had no history of maternal hypertension and had no history of chorionic villus sampling or amniocentesis. The patient was not taking any medications and had no known allergies. Physical exam revealed a well-developed, well-nourished male in no apparent distress. A full skin exam revealed a 1.8 cm × 2 cm discrete, blue-purple vascular nodule with coarse surface telangiectasias and a surrounding rim of pallor on the right shoulder. There was no bleeding or breakdown noted. There was no lymphadenopathy present.