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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.

Birthmarks and congenital naevi

Dermatology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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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.
  • A new persistent hard or rapidly growing nodule, ulcer, unexplained bleeding or focal colour and texture change needs urgent dermoscopic assessment and often biopsy.
  • Café-au-lait macules are smooth uniformly pigmented patches; six or more, segmental clustering or associated freckling and developmental signs should trigger a neurocutaneous assessment.
  • Congenital dermal melanocytosis is a flat blue-grey patch, commonly sacral, which may resemble bruising; record its site and appearance early without assuming trauma.
  • Naevus simplex is a blanching midline pink patch that usually fades, whereas a capillary malformation is persistent, often unilateral and may deepen or thicken with age.
  • A forehead or upper-eyelid capillary malformation can mark Sturge–Weber and glaucoma risk and warrants early specialist ophthalmic and paediatric assessment.
  • Serial photographs require informed consent, a scale, constant lighting and secure clinical storage; images complement rather than replace palpation and dermoscopy.
  • Discuss cosmetic visibility, hair, clothing friction, bullying and family language without implying that treatment is required for social acceptability.

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.

  1. Confirm timing and growth, inspect and palpate the whole lesion, test blanching, measure it and look for satellites and other cutaneous markers.
  2. Complete an age-appropriate eye, neurological, developmental and musculoskeletal screen and ask about seizures, headache, vision, weakness and family history.
  3. Create a consented baseline image and place the lesion into routine reassurance, planned surveillance or urgent specialist assessment according to function and red flags.
CMN surveillanceTrack proportionate growth and focal change

A congenital melanocytic naevus is clinically stable.

  1. Record projected adult size category, anatomical site, hair, nodules and satellite number and provide a clear description of changes that should trigger earlier contact.
  2. Refer large, multiple, difficult-to-monitor or psychosocially burdensome naevi to a specialist team for dermoscopy and consideration of neuroimaging and surgical options.
  3. Review excision as a function, symptom and preference decision, explaining scar and anaesthetic burden and that surgery does not guarantee removal of melanoma risk.

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.Do not apply unmeasured product across a large birthmark or broken skin. Consider distress, procedural sedation needs, allergy and systemic toxicity, and never let anaesthesia planning delay biopsy of a malignant-appearing focus.
No routine preventive medicineThere is no topical or systemic medicine that removes melanoma, glaucoma or neurocutaneous risk from a congenital naevus or capillary malformation.Avoid bleaching products, corrosive remedies and unsupervised topical treatment; manage eczema, ulceration or infection separately without obscuring a changing lesion before assessment.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

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.
  • NICE melanoma assessment and managementUrgent assessment, dermoscopy, photography, biopsy and surveillance principles for suspicious melanocytic change.
  • Caring Matters Now congenital melanocytic naeviUK specialist-network information on CMN phenotype, neurological involvement, surveillance and family support.
  • Great Ormond Street Hospital port-wine stainsCapillary-malformation recognition, Sturge–Weber and glaucoma associations and multidisciplinary care.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom