By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

“MONGOLIAN SPOTS” HARMLESS, CAN BE CONFUSED WITH BRUISES

Question: My husband and I are Asian, and our children both had “Mongolian spots” when they were little. I had to defend myself to many daycare providers that these were not bruises. Now I hear this is happening to a friend of mine with an adopted Asian baby. Could you write something to help people understand these birthmarks?

Answer: Mongolian spots are dark blue to black, flat birthmarks usually found on the lower back or buttocks. The medical name for them is congential dermal melanocytosis. This term refers to melanocytes -- special cells located in the bottom layer of the skin's epidermis that produce a pigment called melanin. The discoloration we call Mongolian spots results when there are an excess number of these pigment-producing cells in the skin.

These marks are usually present at birth, or shortly thereafter, and fade away by puberty. In addition to the lower back region, they can also be found on the legs, sides, shoulder, wrists and ankles. They are flat, pigmented lesions with unclear borders and irregular shapes. There can be several of these marks or just one.

They are very common in non-white babies. In fact, over 90 percent of Native American and African American infants have them. Around 80 percent of Asians and 70 percent of Hispanics have at least one Mongolian spot at birth. They can also occur in fair-skinned people, but this is uncommon.

While they can be large and resemble bruises, they are not related to bruises or any underlying medical condition. They are a just harmless birthmarks that fade away with age. Occasionally, the spots will remain throughout life, but this occurs in only about 5 percent of babies born with the spots.

In and of themselves, these are benign skin discolorations, but they have been known to lead to legal problems. Since Mongolian spots can look like bruises caused by trauma to an untrained person, there have been cases where these spots have resulted in parents being accused of child abuse. It sounds like you are familiar with this unfortunate scenario.

Because of the possibility of this kind of misunderstanding, and as a precautionary measure, I’d recommend that anyone whose son or daughter has these spots, works with the child’s physician to document the birthmarks as soon as they appear. Photographs should be taken and placed in the child’s medical record.

Many communities have educational sessions for police and child care workers around the issue of normal and abnormal skin markings to help minimize the likelihood of false accusations. You might inquire if this is being done in your community, and if not, recommend these types of training sessions.

Your European American friend who adopted a dark-skinned infant may also need education about spots. In this case, documentation should probably also be supplied to the adoption case worker.

There are many other types of birthmarks, but these are the primary ones that can be mistaken for bruising. I hope this information is helpful to you and your friend.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.