A Mongolian Spot, Mongolian Fleck or Mongolian Blue Spot is a blue, bluish-gray, bluish-green or blue-black flat skin markings that appear at birth or shortly thereafter during the infantile age. The edges are usually indistinct and the shapes are irregular. The sizes and the numbers are various.(4)
Mongolian Spots appear commonly at the base of the spine, on the buttocks and back and also can appear on the shoulders. Mongolian spots are benign and are not associated with any conditions or illnesses. Mongolian Spots present at birth and occur in more than 90% of children of Mongoloid race (e.g. East Asians, Polynesians, Indonesians, Micronesians). Mongolian Spots occur less frequently in other races. Mongolian spots are benign lesions that require no treatment. Usually they spontaneously disappear by the time the child reaches 4 years old. Persistent Mongolian spots may be larger and persist for many years.(3) It is important to recognize that Mongolian spots are birthmarks, NOT bruises. (4)
ALTERNATIVE NAMES
Mongolian blue spot, child fleck, sacral fleck, newborn blue fleck, newborn sacral blue fleck, Semitic mark, Semitic stain, congenital dermal melanocytosis, dermal melanocytosis Mongolische Flecken (G), tache mongolique (F), mancha mongolica (S), Moukohan (J). (4)
PHYSICAL
Mongolian spots consist of blue-gray macular pigmentation. The distinctive skin discoloration is due to the deep placement of the pigment in the dermis, which imparts a bluish tone to the skin from the Tyndall effect of scattered light.
Typically, it is a few centimeters in diameter, although much larger lesions also can occur. Lesions may be solitary or numerous.
Most commonly, it involves the lumbosacral area, but the buttocks, flanks, and shoulders may be affected in extensive lesions.
Generalized Mongolian spots involving large areas covering the entire posterior or anterior trunk and the extremities have been reported.
Several variants exist, as follows:
Persistent Mongolian spots are larger, have sharper margins, and persist for many years.
Aberrant Mongolian spots involve unusual sites such as the face or extremities.
Persistent aberrant Mongolian spots also are referred to as macular-type blue nevi.
Mongolian spots have been associated with cleft lip, spinal meningeal tumor, melanoma, and phakomatosis pigmentovascularis types 2 and 5. A few cases of extensive Mongolian spots have been reported with inborn errors of metabolism, the most common being Hurler syndrome, followed by gangliosidosis type 1, Niemann-Pick disease, Hunter syndrome, and mannosidosis. In such cases, they are likely to persist rather than resolve.(2)
DISTRIBUTION
Mongolian Spots appear commonly at the base of the spine, on the buttocks and back and also can appear on the shoulders. Mongolian spots are benign and are not associated with any conditions or illnesses. Mongolian Spots present at birth and occur in more than 90% of children of Mongoloid race (e.g. East Asians, Polynesians, Indonesians, Micronesians). Mongolian Spots occur less frequently in other races. Mongolian spots are benign lesions that require no treatment. Usually they spontaneously disappear by the time the child reaches 4 years old. Persistent Mongolian spots may be larger and persist for many years.(3) It is important to recognize that Mongolian spots are birthmarks, NOT bruises. (4)
ALTERNATIVE NAMES
Mongolian blue spot, child fleck, sacral fleck, newborn blue fleck, newborn sacral blue fleck, Semitic mark, Semitic stain, congenital dermal melanocytosis, dermal melanocytosis Mongolische Flecken (G), tache mongolique (F), mancha mongolica (S), Moukohan (J). (4)
PHYSICAL
Mongolian spots consist of blue-gray macular pigmentation. The distinctive skin discoloration is due to the deep placement of the pigment in the dermis, which imparts a bluish tone to the skin from the Tyndall effect of scattered light.
Typically, it is a few centimeters in diameter, although much larger lesions also can occur. Lesions may be solitary or numerous.
Most commonly, it involves the lumbosacral area, but the buttocks, flanks, and shoulders may be affected in extensive lesions.
Generalized Mongolian spots involving large areas covering the entire posterior or anterior trunk and the extremities have been reported.
Several variants exist, as follows:
Persistent Mongolian spots are larger, have sharper margins, and persist for many years.
Aberrant Mongolian spots involve unusual sites such as the face or extremities.
Persistent aberrant Mongolian spots also are referred to as macular-type blue nevi.
Mongolian spots have been associated with cleft lip, spinal meningeal tumor, melanoma, and phakomatosis pigmentovascularis types 2 and 5. A few cases of extensive Mongolian spots have been reported with inborn errors of metabolism, the most common being Hurler syndrome, followed by gangliosidosis type 1, Niemann-Pick disease, Hunter syndrome, and mannosidosis. In such cases, they are likely to persist rather than resolve.(2)
DISTRIBUTION
Mongolian spots are mostly located at the base of the spine, on the lower back and buttocks. Mongolian Spots can also appear on the shoulders, upper back, arms, wrists, legs, ankles, lateral abdomen and elsewhere. Palms, soles, face and head are usually spared. (4)
RACE
Mongolian blue spots are common among darker skinned races, such as Asian, East Indian, and African. They are flat, pigmented lesions with nebulous borders and irregular shape.(2)
MORTALITY/MORBIDITY
Mongolian spot is not associated with mortality or morbidity.(2)
SEX
No sex predilection is reported.(2)
AGE
Mongolian spot is usually present at birth, but it can also appear within the first weeks of the neonatal period.(2)
VARIANTS
RACE
Mongolian blue spots are common among darker skinned races, such as Asian, East Indian, and African. They are flat, pigmented lesions with nebulous borders and irregular shape.(2)
MORTALITY/MORBIDITY
Mongolian spot is not associated with mortality or morbidity.(2)
SEX
No sex predilection is reported.(2)
AGE
Mongolian spot is usually present at birth, but it can also appear within the first weeks of the neonatal period.(2)
VARIANTS
1) Persistent Mongolian spots are larger and have sharper borders. They may persist for many years.
2) Deep blue Mongolian spots are deeper colored and have sharper borders. They may persist as long as persistent Mongolian spots.
3) Ectopic Mongolian spots or aberrant Mongolian spots involve unusual areas such as the face or extremities.(4)
INCIDENS
INCIDENS
The prevalence of Mongolian spots varies among different ethnic groups according to the overall depth of pigmentation. Mongolian spots are common among Asian, East Indian, and African races, but rare among Caucasian and other races. Reported incidences in representative ethnic infants are as follows: Asian: 95-100%, East African: 90-95%, Native American: 85-90%, Hispanic: 50-70%, Caucasian: 1-10%.(4)
CAUSESMongolian spots are caused by entrapment of melanocytes in the dermis during their migration from the neural crest into the epidermis in fetal development. Microscopically dermal melanocytoses are seen in all newborn babies irrespective of race. Differences in the number of dermal melanocytes may cause the racial variation.(4)
Mongolian spots are thought to be due to entrapment of melanocytes (pigment cells) in the dermis that have failed to reach their proper location in the epidermis in the developing embryo.(3)
PROGNOSIS
The bluish discolorations usually fade after a few years and almost disappear between age 7 to 13 years. Therefore, no treatment is required in most cases.(4)
DIFFERENTIALSBlue nevi, nevi of Ota, and bruises should be differentiated.Occasionally, Mongolian spots are mistaken for bruises caused by child abuse. Careful observation by a specialist will easily allow differentiation.(4)
SIGNS AND TESTS
No tests is needed. Your doctor can diagnose this condition by looking at the skin.(1)
TREATMENT
No treatment is necessary or recommended. (1)
CAUSESMongolian spots are caused by entrapment of melanocytes in the dermis during their migration from the neural crest into the epidermis in fetal development. Microscopically dermal melanocytoses are seen in all newborn babies irrespective of race. Differences in the number of dermal melanocytes may cause the racial variation.(4)
Mongolian spots are thought to be due to entrapment of melanocytes (pigment cells) in the dermis that have failed to reach their proper location in the epidermis in the developing embryo.(3)
PROGNOSIS
The bluish discolorations usually fade after a few years and almost disappear between age 7 to 13 years. Therefore, no treatment is required in most cases.(4)
DIFFERENTIALSBlue nevi, nevi of Ota, and bruises should be differentiated.Occasionally, Mongolian spots are mistaken for bruises caused by child abuse. Careful observation by a specialist will easily allow differentiation.(4)
SIGNS AND TESTS
No tests is needed. Your doctor can diagnose this condition by looking at the skin.(1)
TREATMENT
No treatment is necessary or recommended. (1)
COMPLICATIONS
There are no complications. (1)
PHOTO
Mongolian spot visible on three-month-old Indonesian baby girl
REFERENCES
1. Mongolian Spot DrGreene.com
2. Mongolian Spot emedicine.medscape.com
3. Mongolian Blue Spots health-cares.net
4. Mongolian Spot Tokyo-med.ac.jp
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