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Pigmented Spots & Birthmarks in Newborns

​Did you know at least 2% of all babies are born with a small pigmented spot somewhere on their body? These spots are known as a congenital melanocytic nevus. In a nutshell, a nevus is a birthmark. Melanocytic means that it is pigment-based; Melanin is the pigment found in human skin.

If you notice a pigmented spot on your baby, be sure to show it to your child's pediatrician at his or her next visit. Your pediatrician can identify any spots that would require further testing or ones that are nothing to worry about.

Types of Pigmented Spots in Newborns

Café-au-lait spots

Café-au-lait spots are flat, light tan or light brown spots that are usually shaped like an oval. The skin is normal texture, and the spots do not pose any risk to your child. If your child has a lot of these spots that are larger than a quarter, you should discuss it you're your child's pediatrician as it can be a marker of other diseases.

Mongolian Spot

Mongolian spots are very common in darker skinned babies. They are flat, bluish-gray colored (almost looking like a bruise). They are most commonly found on the lower back and buttocks, and sometimes on the shoulder. Most of them fade somewhat by the time a child reaches age two and have completely disappeared by age five. If Mongolian spots remain at puberty, they are likely to be permanent.

Congenital Melanocytic Nevi

Congenital melanocytic nevi are moles that are present at birth. They are divided into categories depending on their size.

  • Small nevi (less than 3 inches in diameter) are common, occurring in about 1% of all newborns. They tend to grow with the child and usually don't cause any problems. Rarely, however, these moles may develop into a type of serious skin cancer at some later time.
  • Larger congenital nevi (3 inches to the size of a book) might be flat or raised, may have hair growing from it, and can be so large that it covers an arm or a leg. Fortunately, these nevi are very rare (occurring in 1 out of every 20,000 births). Larger congenital nevi have a greater risk of developing into skin cancer than do smaller congenital nevi. It's a good idea to watch them carefully and have them checked by your pediatrician regularly.

If there is any change in the mole's appearance (color, size, or shape), your pediatrician may refer you to a pediatric dermatologist who will advise you on removal and any follow-up care.

Vascular malformations and hemangiomas

These are a varied group of normally colored or pigmented spots that can be raised or flat and represent a growth of normal or abnormal blood vessels. Hemangiomas in infants (often referred to as strawberry hemangiomas) can develop anytime in the first few months of life. They are present in about 10% of infants at one year of age tend to disappear before school age. 

Nevus sebaceous

This is a waxy, yellow-orange, hairless skin spot that is usually found on the head and face. These spots are an overgrowth of the top layer of skin along with hair follicles and glands. By the time a child reaches puberty, these spots often become more irritated and raised. There is also a small risk of these skin lesions changing into a skin cancer during puberty. Typically, surgical removal is recommended by adolescense.

Questions from Parents

My child has a birthmark that I think should be removed for cosmetic reasons. Who should I talk to?

There are many reasons to remove skin spots, including those that may be disfiguring or cosmetically unacceptable. There are also types of skin spots that go away with time, or respond to non-surgical treatments. The first person to talk to would be your child's pediatrician. He or she can advise you on the best course of action. If your pediatrician agrees that the spot should be removed, he or she can refer you to a pediatric specialist who can safely remove the spot. 

What types of doctors take care of children with skin spots at birth?

Pediatricians are trained to recognize all of the most common types of pigmented spots or birthmarks that children have. They will help guide you to the management of these spots and can refer to other pediatric specialists if needed.

  • Pediatric dermatologists are specialists in all types of skin problems, including pigmented spots. They also may be asked to help in the diagnosis and treatment of skin conditions.
  • Pediatric plastic surgeons are trained in the removal of skin spots in cosmetically sensitive areas such as the face, and also are trained in the removal of challenging or large skin spots.

A combination of these types of doctors may be involved in your child's care if needed.

What warning signs should I look for?

If any skin spot concerns you, it should be discussed with your doctor.

  • A spot that changes color, texture, or appearance
  • A spot that appears to be growing
  • A spots that bleeds

Additional Information:

Last Updated
Section on Plastic Surgery (Copyright © 2015 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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