may require high doses of systemic corticosteroid or other chemotherapeutic interventions to control these complications TABLE 69.1 COMPLICATIONS RELATED TO HEMANGIOMAS Anatomic location Associated complication Periocular Beard area Midline prevertebral Genital area Large, facial lesion Amblyopia Airway involvement Tethered cord syndrome; spinal dysraphism Large pelvic area Ulceration PHACES (posterior fossa malformation; large facial hemangioma; arterial anomalies; coarctation of the aorta or other cardiac malformation; eye abnormalities; midline sternal defects) LUMBAR (lower body hemangioma, urogenital anomalies, ulceration, myelopathy, bony deformities, anorectal malformation, arterial anomalies, and renal anomalies) DARKER AND LIGHTER SKIN LESIONS Mastocytoma, Urticaria Pigmentosa Children with mastocytomas or lesions of urticaria pigmentosa present with a single yellow–tan–brown lesion that was present at or soon after birth (mastocytoma) or multiple pigmented macules/papules that erupt during the first year of life (urticaria pigmentosa) One important clue is a history of these lesions becoming red ( Fig 69.16 ), hive-like, or even blistered The lesions may ooze and form crusts, much like impetigo; however, they not respond to topical antibiotics On physical examination, appearance is variable With extensive disease, the surface may have a peau d’orange appearance Some papules are yellow and are easily mistaken for xanthomas When lesions are tan to brown, they may be mistaken for raised moles The key finding is a positive Darier sign, which is physical-induced erythema, swelling, and urtication secondary to scratching and