Morocco is an endemic area of tuberculosis, where lung disease occupies the first place. Skin tuberculosis represents only 1 to 2% of extra pulmonary tuberculosis [1]. Its diagnosis is difficult to establish because of the polymorphism of the anatomo-clinical presentation and the multiplicity of differential diagnoses. We report the case of a child who had developed bifocal tuberculosis after tuberculous contagium, and the skin tuberculosis led to discovering pulmonary tuberculosis. Cutaneous tuberculosis occurs in several clinical forms that can coexist or complicate each other. It remains a current disease, the diagnosis of which is difficult because it is often unknown.In the case of a secondarily ulcerated and irregular nodular skin lesion, failure to respond to conventional treatment should lead to histological and bacteriological examination. Peri-orificial cutaneous tuberculosis, although rare, must also be mentioned in the face of a symptomatology that is dragging and resistant to symptomatic treatment. The improvement of living conditions and the implementation of an anti-tuberculosis control approach are essential for the eradication of the disease.

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.