Mongolian spots as a finding in forensic examinations of possible child abuse–implications for case work

Abstract

Mongolian spots (MS) are congenital dermal conditions resulting from neural crest-derived melanocytes migration to the skin during embryogenesis. MS incidences are highly variable in different populations. Morphologically, MS present as hyperpigmented maculae of varying size and form, ranging from round spots of 1 cm in diameter to extensive discolorations covering predominantly the lower back and buttocks. Due to their coloring, which is also dependent on the skin type, MS may mimic hematoma thus posing a challenge on the physician conducting examinations of children in cases of suspected child abuse. In the present study, MS incidences and distribution, as well as skin types, were documented in a collective of 253 children examined on the basis of suspected child abuse. From these data, a classification scheme was derived to document MS and to help identify cases with a need for recurrent examination for unambiguous interpretation of initial findings alongside the main decisive factors for re-examination such as general circumstances of the initial examination (e. g., experience of the examiner, lighting conditions) and given dermatological conditions of the patient (e. g., diaper rash).

Atypical localized Mongolian spots in dark pigmented skin - a challenge for forensic medical examination

“…The 1.5-year-old girl presented Mongolian spots on the back and on the right side of the trunk, which according to the classification of Kettner et al [14] can be categorized as type III. Kolbe et al [15] reported a 2-month-old girl with extensive Mongolian spots on the back of the trunk, buttocks and both ankles.…”

“…Kettner et al were able to detect Mongolian spots at different locations in 10.27% of 253 children examined. The authors developed a classification scheme according to localization (I -buttocks, II -not buttocks, IIIcombination of I and II) with several subtypes [14].…”

Knowledge of Child Abuse and Neglect among General Practitioners and Pediatricians in Training: A Survey

“…Other features by which melanosis spots can be differentiated from abusive hematomas are, for example, their blurred borders and the absence of associated tenderness, erythema, or swelling [ 30 , 31 ]. Even though there is a low incidence of these spots in the Caucasian (European) population, it is important to know this phenotype in order to distinguish it from child maltreatment [ 32 ].…”

Lyme Disease Misinterpreted as Child Abuse

“…The skin is the largest and most exposed organ [ 23 ]. Cutaneous conditions such as congenital dermal melanocytosis (Mongolian spots), capillary hemangiomas, and arteriovenous malformations can masquerade as skin findings of suspected abuse [ 28 , 29 ]. Heritable hematological disorders such as Bernard-Soulier syndrome (BSS), Glanzmann thrombasthenia (GT), Von Willibrand disease (VWD), hemophilia disorders, and Wiskott-Aldrich syndrome have also been misconstrued for physical abuse [ 22 ].…”