Mongolian Spots
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A Mongolian spot, also known as a slate grey nevus or congenital dermal melanocytosis, is a
benign Malignancy () is the tendency of a medical condition to become progressively worse; the term is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malig ...
, flat,
congenital A birth defect is an abnormal condition that is present at childbirth, birth, regardless of its cause. Birth defects may result in disability, disabilities that may be physical disability, physical, intellectual disability, intellectual, or dev ...
birthmark with wavy borders and an irregular shape. In 1883, it was described and named after Mongolians by Erwin Bälz, a German anthropologist based in Japan, who erroneously believed it to be most prevalent among his Mongolian patients. It normally disappears three to five years after birth and almost always by
puberty Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a female, the testicles i ...
. The most common color is blue, although they can be blue-gray, blue-black or deep brown.


Cause

Mongolian spot is a
congenital A birth defect is an abnormal condition that is present at childbirth, birth, regardless of its cause. Birth defects may result in disability, disabilities that may be physical disability, physical, intellectual disability, intellectual, or dev ...
developmental condition—that is, one existing from birth—exclusively involving the
skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...
. The blue colour is caused by
melanocyte Melanocytes are melanin-producing neural-crest, neural crest-derived cell (biology), cells located in the bottom layer (the stratum basale) of the skin's epidermis (skin), epidermis, the middle layer of the eye (the uvea), the inner ear, vagina ...
s,
melanin Melanin (; ) is a family of biomolecules organized as oligomers or polymers, which among other functions provide the pigments of many organisms. Melanin pigments are produced in a specialized group of cells known as melanocytes. There are ...
-containing cells, that are usually located in the surface of the skin (the
epidermis The epidermis is the outermost of the three layers that comprise the skin, the inner layers being the dermis and Subcutaneous tissue, hypodermis. The epidermal layer provides a barrier to infection from environmental pathogens and regulates the ...
), but are in the deeper region (the
dermis The dermis or corium is a layer of skin between the epidermis (skin), epidermis (with which it makes up the cutis (anatomy), cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from s ...
) in the location of the spot. Usually, as multiple spots or one large patch, it covers one or more of the lumbosacral area (lower
back The human back, also called the dorsum (: dorsa), is the large posterior area of the human body, rising from the top of the buttocks to the back of the neck. It is the surface of the body opposite from the chest and the abdomen. The vertebral c ...
), the
buttock The buttocks (: buttock) are two rounded portions of the exterior anatomy of most mammals, located on the posterior of the pelvic region. In humans, the buttocks are located between the lower back and the perineum. They are composed of a laye ...
s, sides, and
shoulder The human shoulder is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder m ...
s. It results from the entrapment of melanocytes in the lower half to two-thirds of the dermis during their migration from the
neural crest The neural crest is a ridge-like structure that is formed transiently between the epidermal ectoderm and neural plate during vertebrate development. Neural crest cells originate from this structure through the epithelial-mesenchymal transition, ...
to the epidermis during
embryonic development In developmental biology, animal embryonic development, also known as animal embryogenesis, is the developmental stage of an animal embryo. Embryonic development starts with the fertilization of an egg cell (ovum) by a sperm, sperm cell (spermat ...
. Male and female infants are equally predisposed to slate grey nevi. People who are not aware of the background of slate grey nevi may mistake them for bruises, possibly resulting in mistaken concerns about abuse.


Anthropological description

The French anthropologist interested himself in what he called the or coloured birthmark, publishing multiple papers in the , an academic journal covering the cultural anthropology of the Americas. Gessain spent time with the Huehuetla Tepehua people in Hidalgo,
Mexico Mexico, officially the United Mexican States, is a country in North America. It is the northernmost country in Latin America, and borders the United States to the north, and Guatemala and Belize to the southeast; while having maritime boundar ...
, and wrote in 1947 about the spot's "location, shape, colour, histology, chemistry, genetic transmission, and racial distribution". He had previously spent several winters in Greenland, and wrote an overview in 1953 of what was known about the spot. He hypothesised that the age at which it faded in various populations might prove to be a distinguishing characteristic of those groups. Gessain claimed that the spot was first observed amongst the Inuit. Hans Egede Saabye, a Danish priest and botanist, spent 1770–1778 in Greenland. His diaries, published in 1816 and translated into several European languages, contained much ethnographic information. He described the spot on newborns, saying he had seen it often when the infants were presented naked for baptism. A second Danish observer was doctor and zoologist Daniel Frederik Eschricht, mainly based in
Copenhagen Copenhagen ( ) is the capital and most populous city of Denmark, with a population of 1.4 million in the Urban area of Copenhagen, urban area. The city is situated on the islands of Zealand and Amager, separated from Malmö, Sweden, by the ...
. In 1849 he wrote of the "mixed" babies he had delivered at the
lying-in Lying-in is the term given to the European forms of postpartum confinement, the traditional practice involving long bed rest before and after giving birth. The term and the practice it describes are old-fashioned or archaic, but lying-in u ...
hospital. He also says that "the observation made for the first time by Saabye about Inuit children has been completely confirmed by Captain Holbøll", who sent him a fetus pickled in alcohol. Gessain goes on to state that it was only in 1883 that an anthropologist mentions the spot. It was Erwin Bälz, a German working in Tokyo, who described a dark blue mark on Japanese infants. He presented his findings in 1901 in Berlin, and from that point on, Bälz's name was associated with certain skin cells containing pigment. Captain
Gustav Frederik Holm Gustav Frederik Holm (6 August 1849 – 13 March 1940) was a Danish naval officer and Arctic explorer born in Copenhagen. Career He was made commander in the Royal Danish Navy, navy in 1899, was chief of the hydrographic bureau from 1899 to ...
wrote in 1887 that his Greenlandic interpreter Johannes Hansen (known as Hanserak) attested to the existence of the birthmark over the kidney region of newborns, which grows larger as they grow older. That year, the Danish anthropologist Soren Hansen drew the connection between the observations of Bälz in Japan and Saabye in Greenland. "This cannot be a coincidence. It is not the first time that the resemblance between the Japanese and the Eskimo has been pointed out."
Fridtjof Nansen Fridtjof Wedel-Jarlsberg Nansen (; 10 October 1861 – 13 May 1930) was a Norwegian polymath and Nobel Peace Prize laureate. He gained prominence at various points in his life as an explorer, scientist, diplomat, humanitarian and co-founded the ...
, the Norwegian polar explorer, said that the spot was widespread in the mixed Danish-Inuit population of West Greenland. Soren Hansen confirmed this. A missionary in
Bethel, Alaska Bethel () is a city in the U.S. state of Alaska, located on the Kuskokwim River approximately from where the river flows into Kuskokwim Bay. It is the largest community in western Alaska and in the Unorganized Borough and the List of cities in ...
, a traditional gathering place of Yup'ik people, reported that the spots were common on children. Rudolf Trebitsch, an Austrian linguist and ethnologist, spent the summer of 1906 on the West Coast of Greenland, and listed all the examples he came across. Gessain went to north
Labrador Labrador () is a geographic and cultural region within the Canadian province of Newfoundland and Labrador. It is the primarily continental portion of the province and constitutes 71% of the province's area but is home to only 6% of its populatio ...
in 1926, looking for children with these spots. In 1953 Dr Saxtorph, medical advisor to the Greenland department (part of the Danish government), wrote that the Greenlanders do not like outsiders to see or discuss these birthmarks; "they doubtless feel as a reminiscence of the time when they lived on a low cultural level". The presence or absence of the slate grey nevus was used by racial theorists such as Joseph Deniker (1852–1918), the French anthropologist. The ''Journal of Cutaneous Diseases Including Syphilis, Volume 23'' contained several accounts of the slate grey nevus on children in the Americas: In Central America, according to these authorities, the spot is called ''Uits'', "pan", and it is an insult to speak of it. It disappears in the tenth month. It is bluish-reddish (in these Native people), and is remarkable by its small size. The mulberry colored spot is very well known in
Afro-Brazilians Afro-Brazilians (; ), also known as Black Brazilians (), are Brazilians of total or predominantly Sub-Saharan African ancestry. Most multiracial Brazilians also have a range of degree of African ancestry. Brazilians whose African features are mo ...
. In Brazil, among individuals of mixed Indigenous American and West African descent (
pardo In the former Portuguese and Spanish colonies in the Americas, ''pardos'' (feminine ''pardas'') are triracial descendants of Europeans, Indigenous Americans and Africans. History In some places they were defined as neither exclusively ...
) it is called "genipapo", from its resemblance in color (bluish-gray) to an indigenous fruit of Brazil, named genipapo (a Native American word adopted into Portuguese).


Prevalence

Infants may be born with one or more slate grey nevi ranging from a small area on the buttocks to a larger area on the back. The birthmark is prevalent among
East East is one of the four cardinal directions or points of the compass. It is the opposite direction from west and is the direction from which the Sun rises on the Earth. Etymology As in other languages, the word is formed from the fact that ea ...
,
South South is one of the cardinal directions or compass points. The direction is the opposite of north and is perpendicular to both west and east. Etymology The word ''south'' comes from Old English ''sūþ'', from earlier Proto-Germanic ''*sunþa ...
,
Southeast The points of the compass are a set of horizontal, Radius, radially arrayed compass directions (or Azimuth#In navigation, azimuths) used in navigation and cartography. A ''compass rose'' is primarily composed of four cardinal directions—north, ...
, North and Central Asian peoples, Indigenous
Oceania Oceania ( , ) is a region, geographical region including Australasia, Melanesia, Micronesia, and Polynesia. Outside of the English-speaking world, Oceania is generally considered a continent, while Mainland Australia is regarded as its co ...
ns (chiefly
Micronesia Micronesia (, ) is a subregion of Oceania, consisting of approximately 2,000 small islands in the Northwestern Pacific Ocean. It has a close shared cultural history with three other island regions: Maritime Southeast Asia to the west, Poly ...
ns and
Polynesia Polynesia ( , ) is a subregion of Oceania, made up of more than 1,000 islands scattered over the central and southern Pacific Ocean. The indigenous people who inhabit the islands of Polynesia are called Polynesians. They have many things in ...
ns), certain populations in Africa,
Amerindians In the Americas, Indigenous peoples comprise the two continents' pre-Columbian inhabitants, as well as the ethnic groups that identify with them in the 15th century, as well as the ethnic groups that identify with the pre-Columbian population of ...
, non-European
Latin Americans Latin Americans (; ) are the citizens of Latin American countries (or people with cultural, ancestral or national origins in Latin America). Latin American countries and their diasporas are multi-ethnic and multi-racial. Latin Americans are ...
and Caribbeans of mixed-race descent."Mongolian blue spots"
. Health care guide discussing the Mongolian blue spot.
They occur in around 80% of Asians, and 80% to 85% of Native American infants. Approximately 90% of Polynesians and
Micronesians The Micronesians or Micronesian peoples are various closely related ethnic groups native to Micronesia, a region of Oceania in the Pacific Ocean. They are a part of the Austronesian ethnolinguistic group, which has an Urheimat in Taiwan. Eth ...
are born with slate grey nevi, as are about 46% of children in Latin America,"Epidemiology of Mongolian spot"
''MedScape''
where they are associated with non-European descent. These spots also appear on 5–10% of babies of full Caucasian descent.
African American African Americans, also known as Black Americans and formerly also called Afro-Americans, are an Race and ethnicity in the United States, American racial and ethnic group that consists of Americans who have total or partial ancestry from an ...
babies have slate grey nevi at a frequencies of 90% to 96%. According to a 2006 study examining the Mongolian spot among newborns in the Turkish city of
İzmir İzmir is the List of largest cities and towns in Turkey, third most populous city in Turkey, after Istanbul and Ankara. It is on the Aegean Sea, Aegean coast of Anatolia, and is the capital of İzmir Province. In 2024, the city of İzmir had ...
, it was found out that 26% of the examined babies had the condition. It was noted the prevalence rate was 20% and 31% in boys and girls, respectively. The study also reported that no children born with light hair had the mark, meanwhile 47% of the children with dark hair having it. In a study published in Hungary in 2013 a total of 2289 newborn infants underwent whole-body screening skin examinations. At least one skin manifestation was found in 63% of the neonates. The most frequently observed in pigmented lesions were congenital melanocytic naevi and Mongolian spot. Since the last century, extensive research has been made regarding the prevalence of said spot in populations of mixed European-native American ancestry. A publication from 1905, citing field research made by the anthropologist Frederick Starr, states that the spot is not present in
Mestizo ( , ; fem. , literally 'mixed person') is a term primarily used to denote people of mixed European and Indigenous ancestry in the former Spanish Empire. In certain regions such as Latin America, it may also refer to people who are culturall ...
populations; however, Starr's actual research states that "seven Mayan children presented the spot, three mixed children didn't have it"; Starr therefore does not make an absolute judgement, as he does not say how many mixed children were analyzed in total. Nowadays it is completely accepted that the big majority of Mexico's and Latin America's
mixed-race The term multiracial people refers to people who are mixed with two or more races and the term multi-ethnic people refers to people who are of more than one ethnicities. A variety of terms have been used both historically and presently for mul ...
populations have the Mongolian spot and that its presence works as an indicator of the actual degree of mestizaje present in a given population, having its lower frequency in Uruguay with 36%,"El indio en nuestro arte e histiografía"
''IFD de Minas'', retrieved 11 February 2020.
followed by Argentina with an incidence 44%, Mexico with 50%-52%,
, ''El Universal'', 16 January 2012. Retrieved 3 July 2017.
68% in Hispanic-Americans and 88% in highland Peruvians. A study performed in hospitals of
Mexico City Mexico City is the capital city, capital and List of cities in Mexico, largest city of Mexico, as well as the List of North American cities by population, most populous city in North America. It is one of the most important cultural and finan ...
suggests that socioeconomic factors influence the frequency of Mongolian spots among newborns, as evidenced by the higher prevalence of 85% in newborns from a public institution, typically associated with lower socioeconomic status, compared to a 33% prevalence in newborns from private hospitals, which generally cater to families with higher socioeconomic status. According to the
Mexican Social Security Institute The Mexican Institute of Social Security (, IMSS) is a Federal government of the United Mexican States, governmental organization that assists public health, pensions and social security in Mexico operating under the Secretariat of Health (Mexic ...
nationwide, around half of Mexican babies have the slate grey nevus. Central American indigenous children were subjected to racism due to their slate grey nevi but progressive circles began to make having the slate grey nevus popular after the late 1960s. Highland Peruvians have the slate grey nevus.


Treatment

As congenital benign nevi, Mongolian spots do not require treatment and in most cases disappear before adolescence. No cases of malignant degeneration have been reported.


Cultural terminology

The slate grey nevus is referred to in the Japanese idiom (), meaning "to have a blue butt", which is a reference to immaturity or inexperience. In the
Mongolian language Mongolian is the Prestige (sociolinguistics), principal language of the Mongolic languages, Mongolic language family that originated in the Mongolian Plateau. It is spoken by ethnic Mongols and other closely related Mongolic peoples who are nati ...
, it is known as , meaning "blue spot".
Korean mythology Korean mythology () is the group of myths told by historical and modern Koreans. There are two types: the written, literary mythology in traditional histories, mostly about the founding monarchs of List of monarchs of Korea, various historical k ...
explains the nevus as a bruise formed when Samshin halmi or
Samsin Halmoni Samsin Halmeoni (), also called Grandmother Samsin, is the goddess of childbirth and fate in Korean mythology. Name ''Sam'' means "pregnancy" in Korean, s''in'' or ''shin'' means god(dess), ''halmeoni'' means grandmother, a title for a venerat ...
(), a shaman spirit to whom people pray around childbirth, slapped the baby's behind to hasten the baby to quickly get out from the mother's womb. "Mongolian Mark", the middle third of the 2004–05 novel '' The Vegetarian'', is named after the title character's nevus, which obsesses her brother-in-law. In Chinese, it is referred to as (
pinyin Hanyu Pinyin, or simply pinyin, officially the Chinese Phonetic Alphabet, is the most common romanization system for Standard Chinese. ''Hanyu'' () literally means 'Han Chinese, Han language'—that is, the Chinese language—while ''pinyin' ...
: , ). Among common folk it is said to be caused by the Buddhist goddess of childbirth Songzi Guanyin (, pinyin: ; ) when she is slapping the baby's backside, telling it to be born. Others say it is because the baby does not want to leave the mother's womb, so Songzi Guanyin will kick it out, leaving the bruise. A small portion of people wrongfully believe it is caused when the doctor is slapping the baby's backside to make it cry. Scientifically, it is also referred to as (; ). In Khmer, it is known as () which translates to 'Mongolian spot' as well as other skin conditions such as vitiligo and leucoderma. In Spanish it is called and (see Erwin Bälz). The mark is common among Maya people of the Yucatan Peninsula where is referred to as in
Maya Maya may refer to: Ethnic groups * Maya peoples, of southern Mexico and northern Central America ** Maya civilization, the historical civilization of the Maya peoples ** Mayan languages, the languages of the Maya peoples * Maya (East Africa), a p ...
, which means 'circle'. In Ecuador, the native Indians of
Colta Colta may refer to: * Colta District, in Peru * Colta Canton, in Ecuador * Colta.ru, a Russian online publication * Vasile Colța (born 1953), Moldovan politician See also * Kolta (disambiguation) {{Disambiguation, geo, surname ...
are insultingly referred to in Spanish by a number of terms which allude to the slate grey nevus. In Thai, it is known as () which translates to 'ink bottom', or (), which translates to 'blue strain'. has been used to tease those who act, think or speak like a baby, because this Mongolian spot can be seen only during this period of a human being's life. In Iñupiaq, is it called or , which relates to the word for blood and also means 'mole'.


See also

* Nevus flammeus nuchae, also known as stork bite *
List of cutaneous conditions Many skin conditions affect the human integumentary system—the organ system covering the entire surface of the Human body, body and composed of Human skin, skin, hair, Nail (anatomy), nails, and related muscle and glands. The major function o ...


References


External links

{{Congenital malformations and deformations of integument Cutaneous congenital anomalies