The so-called Mongolian spots and suspected child abuse - difficulties in differential diagnosis

The assessment of physical violence against children is an important issue in forensic medicine, particularly in the case of infants and toddlers, who, due to their stage of development, are unable to communicate the violence inflicted upon them. This case describes a two-week-old girl of Roma origin, who was transferred from a temporary to a foster family. While changing the child, the foster parents noticed bruises in the sacral area. Based on the initial assessment of these changes at the hospital, the authorities were notified and an investigation was initiated. The first court expert assessing the changes indicated that the image resembled resorbing haemorrhages resulting from trauma. Another team of experts, consisting of specialists in forensic medicine, dermatology and pathology, was appointed. Based on the analysis of medical records and a physical examination using a dermatoscope, pale-blue spots characteristic of the Mongolian spot were found in the lumbar and buttock areas. Mongolian spots are congenital developmental abnormalities classified as melanocytic naevi. In most cases, the changes appear immediately after birth or shortly thereafter. Clinically, a lesion appears as single or multiple spots on the lower back, sacrum, or buttocks. These lesions can range in colour from dark grey to blue-green and take on various shapes, such as round, oval, or irregular. Lesions on the skin of children can morphologically resemble bruises, so their evaluation requires special attention. In case of doubt as to the nature of the lesion, additional examination should be performed. Furthermore, the analysis of medical records and the evaluation by a dermatologist can be helpful.