What is Dermal Melanocytosis (Mongolian Spots)?
Congenital dermal melanocytosis, often called Mongolian spot or slate gray birthmark, is a common pigment-related birthmark seen in newborns. This condition typically appears as bluish-gray colored spots on the skin from birth or a short time after. The most common places for these spots to occur are on the lower back and buttock area, but they might also appear on the shoulders. They are seen most frequently among Asian and Black patients, affecting both boys and girls equally. Usually, these spots vanish by the time the child is between 1 and 6 years old. These birthmarks are harmless and don’t require treatment as they usually disappear on their own.
What Causes Dermal Melanocytosis (Mongolian Spots)?
Congenital dermal melanocytosis is a condition that occurs when skin cells, known as melanocytes, don’t properly move or clear out from the skin’s dermal layer during the baby’s development in the womb. Currently, there are no known preventative measures for this condition.
Recent studies, however, suggest a link between congenital dermal melanocytosis and certain metabolic disorders present from birth.
Risk Factors and Frequency for Dermal Melanocytosis (Mongolian Spots)
Congenital dermal melanocytosis is a condition that can affect both males and females equally. It usually begins at birth or shortly after, and generally, these skin lesions disappear by the time the child turns one. It’s rare for the condition to persist after the age of six.
Despite affecting all races, it’s more prevalent in certain ethnic groups. Asian and Black populations show the highest rates of this condition. To put this into perspective:
- 81% to 100% of Asian individuals are affected.
- Between 95.5 and 96% of Black individuals are affected.
- 46.3 to 70.1% of Hispanic individuals are affected.
- Only 9.6% of White individuals are affected.
Signs and Symptoms of Dermal Melanocytosis (Mongolian Spots)
Congenital dermal melanocytosis is a condition where one or more dark-colored spots appear on the skin. Most commonly, these spots are located on the lower back, sacrum (the bone at the base of your spine), or buttocks. These spots can differ in color, from dark grey, blue, to blue-green and also vary in shape, such as round, oval, or irregular. Typically, these spots occur at or shortly after birth, usually covering less than 5% of the total body surface area. There are some cases where these spots appear in unusual or ‘extra-sacral’ regions like the lower and upper limbs, groin, shoulder, and chest.
If these extra-sacral spots appear on the face or orbits (the cavities containing the eyes), it might be a different condition known as Nevus of Ota.
Many congenital dermal melanocytosis spots tend to fade by the time the child is one year old and very rarely do they stay past six years. However, spots that are extra-sacral, larger than 10 cm, or darker in color are more likely to stay beyond one year.
In order to diagnose this condition, doctors usually ask parents or caregivers about when these spots appeared and where they are located. While these spots are usually harmless, they can look a bit like bruises that might be caused by non-accidental injury. Therefore, doctors ensure to document these spots during the initial evaluation to avoid any confusion in future visits. Furthermore, doctors need to distinguish these spots from similar-looking conditions, such as a Nevus of Ota (dark pigmentation around the face and eyes, usually on one side) and Nevus of Ito (dark pigmentation involving the neck, upper chest, and shoulder blade areas).
Testing for Dermal Melanocytosis (Mongolian Spots)
Congenital dermal melanocytosis is a harmless condition that doesn’t require further lab tests, X-rays, or tissue sample examinations.
However, if a patient has Nevus of Ota (oculodermal melanocytosis), which can involve the white part of the eye (sclera), an eye exam is necessary.
Treatment Options for Dermal Melanocytosis (Mongolian Spots)
Congenital dermal melanocytosis, a type of skin discoloration, typically fades away within the first year of life and rarely lasts beyond the age of six. However, if they are located outside the lower back area and are causing some cosmetic concern, they can be treated. There has been a reported case of successful improvement of this condition located on the lower jaw area. The individual saw a significant change after undergoing four treatments using a specific type of laser (a 755-nm Q-switched alexandrite laser).
What else can Dermal Melanocytosis (Mongolian Spots) be?
When trying to diagnose gray-blue skin patches, doctors consider a variety of similar conditions and ensure it’s not the result of physical abuse. One such condition is Nevus of Ota, which is a type of skin discoloration that typically occurs on one side of the face and around the eye. This condition doesn’t fade over time and can sometimes be linked to a skin growth in the eye that may need to be surgically removed.
Another condition that could cause these patches is Nevus of Ito. This causes pigmentation discoloration on the neck, just above the collarbone and on the shoulder blade. It is crucial to monitor any rapid growth of nodules seen in Nevus of Ito as this may indicate the rare occurrence of the condition becoming cancerous.
Doctors should also consider the possibility of non-accidental injury if the patches are located in unusual areas or if the person feels pain when the area is touched or if there are multiple injuries at different healing stages.
What to expect with Dermal Melanocytosis (Mongolian Spots)
Congenital dermal melanocytosis is a harmless condition that typically disappears by the time a person reaches ten years old. Unlike the conditions called nevus of Ota or nevus of Ito, congenital dermal melanocytosis does not turn into cancer.
Possible Complications When Diagnosed with Dermal Melanocytosis (Mongolian Spots)
For those who have lingering extra-sacral lesions, they might consider getting treatment for these, especially for cosmetic reasons.
Recovery from Dermal Melanocytosis (Mongolian Spots)
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Preventing Dermal Melanocytosis (Mongolian Spots)
Parents should be aware that congenital dermal melanocytosis is a harmless skin condition that naturally goes away without any additional treatment or monitoring. Education for parents includes understanding that this condition usually disappears by the time a child turns one and hardly ever lasts beyond six years. If there are any skin spots that remain beyond this period, they can be treated cosmetically with laser therapy if desired.