Newborn - Birthmark, possible hemangioma

Patient

Q: My daughter is a newborn; 4 weeks old. Upon her birth there was no sign of any issue, but within a few hours she had discoloration that covered most of her hand, her entire forearm, and half of her upper arm. It started as red with two black spots, one on her palm and another on her forearm. Each of these spots were approximately the size of a dime. But, now as time progresses, the redness in her arm has deepened to what appears more purplish as time, and is also now puffy with a couple of "rolls" that are not present on her other arm.

She has an appointment next week and I need advice (IE: second opinions) before approaching her pediatrician. At her initial appointment the arm didn't appear terrible and it was determined to wait, watch, and see as there was a chance that it could be bruising from a cord wrapping. But, that does not appear to be the case. And, I, unfortunately, currently reside in an area with few specialists and would hate for that to effect my daughter's entire life and well being.

Is this an hemangioma? Is it cavernous or deep? Is MRI and/or CT the best next step? What can I expect since it has already formed puffiness and rolls? I'm concerned about damage, not necessarily cosmetic. I'd obviously rather not have any concerns for her, but she is perfect and some splotchy skin doesn't change that.

Thank you for your help. The picture does not show the 'rolls' very well, but they are definitely present when her arm is inspected.

Symptoms:  birthmark, possible hemangioma
Doctor

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