Mongolian spots
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A Mongolian spot, also known as slate grey nevus or congenital dermal melanocytosis, is a
benign Malignancy () is the tendency of a medical condition to become progressively worse. Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous ''benign'' tumor in that a malignancy is not s ...
, flat, congenital
birthmark A birthmark is a congenital, benign irregularity on the skin which is present at birth or appears shortly after birth—usually in the first month. They can occur anywhere on the skin. Birthmarks are caused by overgrowth of blood vessels, melanocy ...
with wavy borders and an irregular shape. In 1883, it was described and named after
Mongolians The Mongols ( mn, Монголчууд, , , ; ; russian: Монголы) are an East Asian ethnic group native to Mongolia, Inner Mongolia in China and the Buryatia Republic of the Russian Federation. The Mongols are the principal member of ...
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 girl, the testes in a bo ...
. The most common color is blue, although they can be blue-gray, blue-black or deep brown.


Cause

Mongolian spot is a congenital 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 de ...
. The blue colour is caused by melanocytes,
melanin Melanin (; from el, μέλας, melas, black, dark) is a broad term for a group of natural pigments found in most organisms. Eumelanin is produced through a multistage chemical process known as melanogenesis, where the oxidation of the amino ...
-containing cells, that are usually located in the surface of the skin (the epidermis), but are in the deeper region (the dermis) 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, 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 column runs ...
), the
buttock The buttocks (singular: 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 compose ...
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 mak ...
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 Neural crest cells are a temporary group of cells unique to vertebrates that arise from the embryonic ectoderm germ layer, and in turn give rise to a diverse cell lineage—including melanocytes, craniofacial cartilage and bone, smooth muscle, per ...
to the epidermis during embryonic development. Male and female infants are equally predisposed to slate grey nevus. People who are not aware of the background of the slate grey nevus may mistake them for bruises, possibly resulting in mistaken concerns about abuse.


Anthropological description

The French anthropologist Robert Gessain interested himself in what he called the ''tache pigmentaire congenitale'' or coloured birthmark, publishing multiple papers in the '' Journal de la Société des Américanistes'', an academic journal covering the cultural anthropology of the Americas. Gessain spent time with the
Huehuetla Tepehua Huehuetla Tepehua is a moribund Tepehua language spoken in Huehuetla, northeastern Hidalgo, Mexico Mexico (Spanish language, Spanish: México), officially the United Mexican States, is a List of sovereign states, country in the southern po ...
people in
Hidalgo Hidalgo may refer to: People * Hidalgo (nobility), members of the Spanish nobility * Hidalgo (surname) Places Mexico * Hidalgo (state), in central Mexico * Hidalgo, Coahuila, a town in the north Mexican state of Coahuila * Hidalgo, Nuevo Le ...
,
Mexico Mexico (Spanish: México), officially the United Mexican States, is a country in the southern portion of North America. It is bordered to the north by the United States; to the south and west by the Pacific Ocean; to the southeast by Guatema ...
, 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 Daniel Frederik Eschricht (18 March 1798 – 22 February 1863) was a Danish zoologist, physiologist, and anatomist known as an authority on whales. He was born in Copenhagen, and studied medicine at Frederiks Hospital, graduating in 1822. He was a ...
, mainly based in
Copenhagen Copenhagen ( or .; da, København ) is the capital and most populous city of Denmark, with a proper population of around 815.000 in the last quarter of 2022; and some 1.370,000 in the urban area; and the wider Copenhagen metropolitan ar ...
. 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 it used to be c ...
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 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, 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 ( esu, Mamterilleq) is a city in Bethel Census Area, Alaska, Bethel Census Area, Alaska, United States. It is the largest community on the Kuskokwim River, located approximately upriver from where the river flows into Kuskokwim Bay. It ...
, a traditional gathering place of
Yup'ik people The Yup'ik or Yupiaq (sg & pl) and Yupiit or Yupiat (pl), also Central Alaskan Yup'ik, Central Yup'ik, Alaskan Yup'ik ( own name ''Yup'ik'' sg ''Yupiik'' dual ''Yupiit'' pl; russian: Юпики центральной Аляски), are an I ...
, 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 , nickname = "The Big Land" , etymology = , subdivision_type = Country , subdivision_name = Canada , subdivision_type1 = Province , subdivision_name1 ...
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 Joseph Deniker (russian: Иосиф Егорович Деникер, ''Yosif Yegorovich Deniker''; 6 March 1852, in Astrakhan – 18 March 1918, in Paris) was a Russian and French naturalist and anthropologist, known primarily for his attempts t ...
(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 ( pt, afro-brasileiros; ) are Brazilians who have predominantly African ancestry (see " preto"). Most members of another group of people, multiracial Brazilians or ''pardos'', may also have a range of degree of African ancestry. ...
. In Brazil, among individuals of mixed Indigenous American and West African descent (
pardo ''Pardos'' (feminine ''pardas'') is a term used in the former Portuguese and Spanish colonies in the Americas to refer to the triracial descendants of Southern Europeans, Amerindians and West Africans. In some places they were defined as ne ...
) it is called "genipapo", from its resemblance in color (bluish-gray) to an indigenous fruit of Brazil, named genipapo (a Native word adopted into Portuguese).


Prevalence

Infants may be born with one or more slate grey nevus ranging from small area on the buttocks to a larger area on the back. The birthmark is prevalent among
East East or Orient 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 fac ...
, South,
Southeast The points of the compass are a set of horizontal, radially arrayed compass directions (or azimuths) used in navigation and cartography. A compass rose is primarily composed of four cardinal directions—north, east, south, and west—each sepa ...
, North and Central Asian peoples, Indigenous
Oceania Oceania (, , ) is a geographical region that includes Australasia, Melanesia, Micronesia, and Polynesia. Spanning the Eastern and Western hemispheres, Oceania is estimated to have a land area of and a population of around 44.5 million ...
ns (chiefly
Micronesia Micronesia (, ) is a subregion of Oceania, consisting of about 2,000 small islands in the western Pacific Ocean. It has a close shared cultural history with three other island regions: the Philippines to the west, Polynesia to the east, and ...
ns and
Polynesia Polynesia () "many" and νῆσος () "island"), to, Polinisia; mi, Porinihia; haw, Polenekia; fj, Polinisia; sm, Polenisia; rar, Porinetia; ty, Pōrīnetia; tvl, Polenisia; tkl, Polenihia (, ) is a subregion of Oceania, made up of ...
ns), certain populations in Africa,
Amerindians The Indigenous peoples of the Americas are the inhabitants of the Americas before the arrival of the European settlers in the 15th century, and the ethnic groups who now identify themselves with those peoples. Many Indigenous peoples of the Am ...
, non-European
Latin Americans Latin Americans ( es, Latinoamericanos; pt, Latino-americanos; ) 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-et ...
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 are born with slate grey nevus, as are about 46% of children in Latin America,Epidemiology of Mongolian spot on MedScape
/ref> where they are associated with non-European descent. These spots also appear on 5–10% of babies of full Caucasian descent;
Coria del Río Coria del Río is a small town near Seville, on the shores of Guadalquivir river. History Early in the 17th Century, ''daimyō'' Date Masamune of Sendai sent a delegation led by Hasekura Tsunenaga (1571–1622) to Europe. In 1613, Hasekura and th ...
in Spain has a high incidence due to the presence of descendants of members of the delegation led by
Hasekura Tsunenaga was a kirishitan Japanese samurai and retainer of Date Masamune, the daimyō of Sendai. He was of Japanese imperial descent with ancestral ties to Emperor Kanmu. Other names include Philip Francis Faxicura, Felipe Francisco Faxicura, and Phi ...
, the first Japanese official envoy to Spain in the early 17th century.
African American African Americans (also referred to as Black Americans and Afro-Americans) are an ethnic group consisting of Americans with partial or total ancestry from sub-Saharan Africa. The term "African American" generally denotes descendants of ens ...
babies have slate grey nevus 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 ( , ; ), also spelled Izmir, is a metropolitan city in the western extremity of Anatolia, capital of the province of the same name. It is the third most populous city in Turkey, after Istanbul and Ankara and the second largest urban aggl ...
, 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. Since the last century, extensive research has been made regarding the prevalence of said spot in populations of mixed European-Amerindian ancestry. A publication from 1905, citing field research made by the anthropologist Frederick Starr, states that the spot is not present in Mestizo populations, however, if Starr's actual research is consulted it is observed the he declares 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 Mixed race people are people of more than one race or ethnicity. A variety of terms have been used both historically and presently for mixed race people in a variety of contexts, including ''multiethnic'', ''polyethnic'', occasionally ''bi-eth ...
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 February 11, 2020.
followed by Argentina with an incidence 44%, Mexico with 50%-52%,
''El Universal'', 16 de enero de 2012. Retrieved July 3, 2017.
68% in Hispanic-Americans and 88% in highland Peruvians. A study performed in hospitals of
Mexico City Mexico City ( es, link=no, Ciudad de México, ; abbr.: CDMX; Nahuatl: ''Altepetl Mexico'') is the capital city, capital and primate city, largest city of Mexico, and the List of North American cities by population, most populous city in North Amer ...
reported that, on average, 51.8% of Mexican newborns presented slate grey nevus, while it was absent on 48.2% of the analyzed babies. According to the Mexican Social Security Institute nationwide, around half of Mexican babies have the slate grey nevus. Central American indigenous children were subjected to racism due to their slate grey nevus 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 a congenital benign
nevus Nevus (plural nevi) is a nonspecific medical term for a visible, circumscribed, chronic lesion of the skin or mucosa. The term originates from ''nævus'', which is Latin for "birthmark"; however, a nevus can be either congenital (present at bir ...
, 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 Japanese may refer to: * Something from or related to Japan, an island country in East Asia * Japanese language, spoken mainly in Japan * Japanese people, the ethnic group that identifies with Japan through ancestry or culture ** Japanese diaspor ...
idiom ''shiri ga aoi'' (), meaning "to have a blue butt", which is a reference to immaturity or inexperience. In Mongolian language, it is known as "Хөх толбо".
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 various historical kingdoms, and the much l ...
explains the nevus as a bruise formed when Samshin halmi or
Samsin Halmoni Samsin halmeoni ( Korean: 三神 할머니), the ''Grandmother Samsin'', is the triple goddess of childbirth and fate in Korean mythology. Name ''Samsin'' or ''Samshin'' means "Three Goddesses" in Korean, (literally, three spirits) and they ap ...
( ko, 삼신할머니), 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 2004–5 novel ''
The Vegetarian ''The Vegetarian'' () is a South Korean three-part novel written by Han Kang and first published in 2007. Based on Han's 1997 short story "The Fruit of My Woman", ''The Vegetarian'' is set in modern-day Seoul and tells the story of Yeong-hye, a ...
'', is named after the title character's nevus, which obsesses her brother-in-law. In Chinese, it is referred to as " 青痕" (Pinyin: Qīng Hén; literally: blue mark). Among common folk it is said to be caused by the Buddhist goddess of childbirth Songzi Guanyin (Simplified Chinese: 送子观音; Pinyin: Sòng Zǐ Guān Yīn; literally: the goddess of baby sending) 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 " 蒙古斑" (Pinyin: Měng Gǔ Bān; literally: mongolian spot) In Khmer, it is known as "khnau" (ខ្នៅ) which translates to 'Mongolian spot' as well as other skin conditions such as vitiligo and leucoderma. The mark is also common among Maya people of the Yucatan Peninsula where is referred to as ''Wa'' in
Maya Maya may refer to: Civilizations * Maya peoples, of southern Mexico and northern Central America ** Maya civilization, the historical civilization of the Maya peoples ** Maya language, the languages of the Maya peoples * Maya (Ethiopia), a popul ...
, 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 Vasile Colța (born 1953) is a Moldovan politician. Biography He served as member of the Parliament of Moldova ( ...
are insultingly referred to in Spanish by a number of terms which allude to the slate grey nevus. In Spanish it is called ''mancha mongólica'' and ''mancha de Baelz'' (see Erwin Bälz). In Iñupiaq, is it called ''auttaq'' or ''auktaq'', which relates to the word for blood and also means 'mole'.https://library.alaska.gov/hist/hist_docs/docs/anlm/200078.pdf


See also

* Nevus flammeus nuchae, also known as stork bite * List of cutaneous conditions


References


External links

{{Congenital malformations and deformations of integument Cutaneous congenital anomalies