Cutis Marmorata Telangiectatica Congeita (CMTC)

Cutis marmorata telangiectatica congeita is a rare, deep purple, marble- or net-like birthmark. It is mostly cosmetic, and while it is present at birth, it fades considerably over a child's first year.

• It forms as a result of abnormal blood vessels (aka a vascular anomaly).
• CMTC poses little health risk and rarely needs to be treated; less than 1 percent of children who have CMTC receive any treatment for it.

CMTC is primarily a cosmetic concern. Sometimes children with CMTC are more affected by cold temperatures than other children. The birthmark often becomes more prominent during cold weather.

The only sign of CMTC is the birthmark itself: a deep purple, net-like staining pattern that usually appears on your child’s trunk or legs.

In rare cases CMTC can lead to:

• Ulceration (bleeding) of the areas of the skin where the birthmark appears, sometimes accompanied by pain
• Slower growth of the limb where the birthmark appears, which can result in your child’s legs being of different lengths and could lead to trouble and/or pain with walking

However, these symptoms occur in less than 1 percent of children with CMTC.

No one knows the cause of CMTC.

If you believe that your child may have CMTC, the first step to making a diagnosis is a complete medical history and thorough physical exam. That initial exam generally provides enough information to diagnose and confirm CMTC.

If your child’s doctor suspects another condition might also be present, she may recommend an imaging study such as the following:

• X-ray: An X-ray is usually the first procedure performed; it gives your child’s doctor information regarding the need for further testing.
• Computerized tomography (CT or CAT): A CT scan shows detailed images of a specific area of your child’s body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
• Magnetic resonance imaging (MRI): This high-resolution scan allows the doctor to detect any related abnormality in your child’s muscles, nerves, bones, and blood vessels.

We advise consulting a vascular anomalies specialist in a few situations:

• If your child’s birthmark seems to be growing
• If your child has any pain or bleeding from the birthmark
• If your child’s birthmark appears on her face
• If your child has CMTC in conjunction with knee, hip, or leg pain. This can be a sign that her legs are growing at different rates; and while she may not require treatment, it’s important to keep an eye on the condition.

Cutis marmorata telangiectatica congeita often fades on its own over the first year as your child’s skin matures and thickens. Your child’s doctor will probably recommend observation after making sure that no other abnormalities are present.

A device called a pulsed dye laser can destroy abnormal blood vessels (telangiectasias) that remain after the CMTC has faded. Pulsed dye laser is the gold standard of treatment for telangiectasias because it is highly effective, doesn't damage the surrounding skin, and rarely causes scarring. Your child's doctor can explain pulsed dye laser therapy and its side effects.

In very rare cases, CMTC can affect the growth of your child’s limb (usually the leg), causing one leg to grow faster or slower than the other. Should your child develop this or any other complications related to CMTC, we’ll refer her to the appropriate specialists within Boston Children's to design a treatment plan.

CMTC typically improves on its own. If it fades, it does not return.

After diagnosis and/or treatment, your child's physician and other members of your care team will develop a schedule of follow-up visits. The main purpose of these follow-up appointments will be to ensure that the CMTC is not affecting the growth of your child’s limbs.

While there are no lasting effects of CMTC, as your child gets older, she may be uncomfortable with the skin lesion, especially if it’s in a prominent location such as on the face or neck. Our counselors can help your child deal with the psychological and social issues related to having a birthmark.

The Vascular Anomalies Center at Boston Children's takes an interdisciplinary approach to care with every child they see. While cutis marmorata telangiectatica congeita is typically only a cosmetic issue, on your first visit to clinic, several VAC specialists will often review you child's case at the same time. Our experience in treating numerous patients with CMTC gives us the depth of knowledge about what symptoms to look for and how to plan treatment accordingly.

Once a diagnosis and the extent of the disease is confirmed, the team works with you to develop and carry out a comprehensive and coordinated care plan that matches your child's specific needs. The team brings the expertise of other Boston Children's departments and services as necessary to provide your child with the best care.