Sep 18, 2011

Does your baby (or toddler) have one or more large birthmarks (also called congenital nevi)? “Nevus” is another name for mole, and the plural is nevi (rhymes with Levi). “Congenital” means present at birth. For this article I consulted with dermatologist Dr. Joshua Fox, founder and director of New York and New Jersey-based Advanced Dermatology P.C.

Since I already knew that large birthmarks are more likely to become melanoma than are smaller moles, and since the general advice from dermatologists is to have moles, that are bigger than the size of a pencil eraser, electively removed, I wondered:

Should very large moles on a baby be electively removed?

I wasn’t thinking in terms of cosmetic reasons, but in terms of eliminating that increased risk of melanoma. I have seen toddlers and children with huge nevi – they didn’t even look like typical birthmarks or moles – they were giant, erratically shaped patches of dark purplish-brown. And whenever I see this, I think as a layperson, “Get that thing removed! It can become melanoma!”

Dr. Fox explains, “About 5 percent of the large congenital nevi have a risk of turning into melanoma.” To me, 5 percent sounds alarming enough to have a baby’s large birthmark removed. Otherwise, the parent might be facing indefinite anxiety. And so might the baby once he or she grows up and learns that very large birthmarks have a heightened chance for transformation into melanoma.

But Dr. Fox continues, “These nevi must be observed” for possible signs of melanoma. Signs are: a change in appearance over time; jagged, uneven edges (though the bigger a nevus, the more irregular its border will be); red spots in the lesion; different colors like grey or black; and bleeding without having been scratched.

This sounds scary, but should a parent arrange to have a baby’s large birthmarks surgically removed?

Dr. Fox explains, “However, it is not required to excise all large congenital nevi which do not possess the characteristics to become melanoma. Also, many excisions will leave a scar behind which is not very pleasing to many patients due to cosmetic reasons. There are institutions and some pediatric dermatologists who have advocated for removal of larger dysplastic nevi both to decrease anxiety, lower malpractice risk, and potentially help patients. This is not my approach or the accepted standard for many reasons.” The term “dysplastic” refers to atypical in appearance.

Removal of large birthmarks on a baby may be impractical.

If a baby has many huge dysplastic nevi or birthmarks, this can present a problem as far as removal, versus if the baby has only one large birthmark. Remember, only 5 percent can become melanoma, so what parents need to do is monitor large birthmarks in their baby via monthly visual inspections, and a baseline photo should be taken; just keep track of your baby’s birthmarks and they may never need to be removed.