Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Birthmark with acute functional or malignant concern
A rapidly enlarging hard nodule, spontaneous ulceration or bleeding within a congenital melanocytic naevus, a forehead or upper-eyelid capillary malformation with acute eye symptoms, or new seizures, focal neurology, raised intracranial pressure or developmental regression requires urgent specialist assessment.
Action: Protect the eye or bleeding surface, document the new change, and arrange same-day paediatric, ophthalmic, neurological or dermatology review according to the threatened function; biopsy a suspicious evolving focus through the specialist pathway rather than delaying with routine photography alone.
Synopsis
Recognise common vascular and melanocytic birthmarks, identify lesions that signal ocular, neurological or malignant risk, and plan proportionate photography, imaging, biopsy, surveillance and family support.
First decide whether a mark is melanocytic, vascular, epidermal or pigmentary and whether it was truly present at birth or became visible during infancy.
Congenital melanocytic naevi are brown to black, sometimes hairy plaques whose projected adult size, anatomical site and satellite count guide melanoma and neurocutaneous-melanocytosis risk.
Most small solitary congenital naevi need baseline documentation and change-aware follow-up rather than prophylactic excision solely to prevent melanoma.
Key red flags
New firmness, disproportionate growth, persistent ulceration, bleeding or pain in a congenital naevus; multiple or very large naevi with neurological symptoms; a segmental forehead or eyelid capillary malformation; or a birthmark associated with seizures, weakness, glaucoma symptoms, developmental change or a new mass warrants prompt specialist review.
Concerning change within a naevus
A focal hard nodule, rapid growth out of proportion to the child, persistent ulceration, spontaneous bleeding, pain or new regional nodes is a diagnostic change rather than a routine cosmetic issue.
Investigation priorities
01
Structured baseline examinationFirst step
Classify the lesion and find extracutaneous clues that alter urgency.
Management branches
First-line classificationName the tissue and map the risk
A congenital or early-life mark is seen without acute illness.
Confirm timing and growth, inspect and palpate the whole lesion, test blanching, measure it and look for satellites and other cutaneous markers.
Complete an age-appropriate eye, neurological, developmental and musculoskeletal screen and ask about seizures, headache, vision, weakness and family history.
CMN surveillanceTrack proportionate growth and focal change
A congenital melanocytic naevus is clinically stable.
Key medicines
Local anaesthetic for selected proceduresUse an age- and product-appropriate topical or infiltrated local anaesthetic regimen determined by the procedural team; calculate maximum dose by weight and record the total delivered.
No routine preventive medicineThere is no topical or systemic medicine that removes melanoma, glaucoma or neurocutaneous risk from a congenital naevus or capillary malformation.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.
NHS birthmarksRecognition, natural history, referral triggers and common treatment choices for vascular and pigmented birthmarks.