Classified by their most prominent vessel type, congenital vascular tumors and malformations are frequently evident neonatally. Although many are identified in the first month of life, management is often delayed due to their slow expansion. Urgent interventions may be necessary in fast-growing, obstructive, destructive, or bleeding anomalies. Treatment is based on the impact on vital structures, impending aesthetic outcome, or functional risks. Frequent and fast-growing hemangiomas and lymphatic malformations are the most commonly treated neonatally. This article reviews lesions that might require early intervention, including hemangiomas, lymphatic and venous malformations, and the rare kaposiform hemangioendothelioma.