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SM Journal of Pediatrics

Congenital Dermal Melanocytosis in Skin of Color and Its Misdiagnosis as Child Abuse

[ ISSN : 3067-9990 ]

Abstract
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Received: 16-Sep-2025

Accepted: 20-Oct-2025

Published: 22-Oct-2025

Review Article | Volume 5 - Issue 1 | Article DOI :

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Calista Persson1*, Kareena Chawla2, Isma Faisal3, Emily Garelick4, Natalie Govea5, Faith Jean6, and Riya Batra7

1Nova Southeastern University Kiran Patel College of Osteopathic Medicine, USA

2Nova Southeastern University Kiran Patel College of Allopathic Medicine, USA

3University of Central Florida, USA

4Philadelphia College of Osteopathic Medicine, USA

5Burrell College of Osteopathic Medicine, USA

6Meharry Medical College, School of Medicine, USA

7Orlando College of Osteopathic Medicine, USA

Corresponding Author:

Calista Persson, Nova Southeastern University Kiran Patel College of Osteopathic Medicine, USA, Tel: (904) 305-7943

Keywords

Congenital dermal melanocytosis; Mongolian spots; Skin of color; Child abuse; Bruise mimics; Pediatric dermatology

Abstract

Background/Objectives: Congenital Dermal Melanocytosis (CDM), historically called Mongolian spots, are benign bluish-gray or green pigmented birthmarks most often located on the lumbosacral region of infants with skin of color. Although harmless and usually fading by school age, their resemblance to bruises can lead to misdiagnosis of child abuse, with serious clinical and forensic consequences. This review examines the epidemiology, clinical features, and diagnostic challenges of CDM, and explores cases and factors contributing to its misidentification as inflicted injury.

Methods: A narrative literature review (2015-2025) was performed, including case reports, series, observational studies, and clinical trials retrieved from pediatric and dermatology databases. Foundational older sources were included for historical context.

Results: CDM prevalence is 50–90% in Asian, African, and Hispanic infants, but <10% in Caucasian infants. Lesions are flat, blue gray or blue-green, with indistinct borders and most often lumbosacral. Misdiagnoses occur in atypical sites (e.g., limbs) or without prior documentation. Provider inexperience, limited skin of color training, and implicit bias contribute to errors..

Conclusions: CDM can be distinguished from bruising by congenital onset, stable appearance, and absence of tenderness or color change. Dermoscopy, short-interval follow-up, and documentation at birth aid recognition. Interdisciplinary collaboration between pediatrics, dermatology, and child protection is essential. Improving awareness and education will prevent false abuse allegations while ensuring true abuse is not missed.

Abbreviations: CDM: Congenital Dermal Melanocytosis; CHAMP: Child Abuse Medical Provider Program.

Citation

Syed IM, Chawla K, Faisal I, Garelick E, Govea N et al, (2025) Congenital Dermal Melanocytosis in Skin of Color and Its Misdiagnosis as Child Abuse. SM J Pediatr 6(1): 8.