Neonatal Pigmented Lesions Cheatsheet
Key Concept: Mongolian spots (CDM) = flat, blue-gray, NONTENDER, present at BIRTH, over sacrum. Management = REASSURANCE. Key differentiator from bruising: nontender, present from birth, characteristic location.
| Diagnosis | Key Features |
|---|
| Congenital Dermal Melanocytosis |
- Flat, blue-gray patches over sacrum/buttocks at birth
- Nontender; present since birth; more common in darker-skinned infants
- Fades spontaneously by age 5; no treatment needed
- Management: REASSURANCE + document at each visit (can mimic bruising)
|
| Bruising / Non-Accidental Trauma |
- Varying colors (yellow, green, purple) at different healing stages
- TENDER to palpation; pattern inconsistent with reported history
- Evaluation: CBC + coagulation studies, skeletal survey
|
| Infantile Hemangioma |
- Bright red, raised plaque appearing days–weeks AFTER birth (not at birth)
- Proliferates age 0–12 mo; involutes after age 1–5 yr
- Treatment (high-risk): oral propranolol
|
| Café-au-Lait Macule |
- Light-brown (café-au-lait) flat macule; ≥6 lesions + ≥5mm → NF1 screen
- Associated with neurofibromatosis type 1 (NF1) and McCune-Albright
|