|Synonyms||Mongolian blue spot, congenital dermal melanocytosis, dermal melanocytosis|
|Mongolian spot visible on six-month-old Taiwanese baby girl|
|Classification and external resources|
|ICD-10||D22.5 (ILDS D22.505)|
|ICD-9-CM||757.33 (CDC/BPA 757.386)|
Mongolian spot is a benign, flat, congenital birthmark with wavy borders and irregular shape. In 1883 it was described and named after Mongolians by Erwin Bälz, a German anthropologist based in Japan. It normally disappears three to five years after birth and almost always by puberty. The most common color is blue, although they can be blue-gray, blue-black or deep brown.
The Mongolian spot is a congenital developmental condition—that is, one existing from birth—exclusively involving the skin. The blue colour is caused by melanocytes, melanin-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 buttocks, sides, and shoulders. It results from the entrapment of melanocytes in the lower half to two-thirds of the dermis during their migration from the neural crest to the epidermis during embryonic development.
Male and female infants are equally predisposed to Mongolian spot.
Infants may be born with one or more Mongolian spots ranging from small area on the buttocks to a larger area on the back.
The spot is prevalent among East, South, Southeast, North and Central Asian peoples, Indigenous Oceanians (chiefly Micronesians and Polynesians), Sub-Saharan Africans, Amerindians, non-European Latin Americans, Caribbeans of mixed-race descent, and Turkish people. They occur in about 90-95% of Asian and 80-85% Native American infants. Approximately 90% of Polynesians and Micronesians are born with Mongolian spots, as are about 46% of children in Latin America, where they are associated with non-European descent. These spots also appear on 5-10% of babies of full Caucasian descent; Coria del Río in Spain has a high incidence due to the presence of descendants of the first Japanese official envoy to Spain in the early 17th century. Black babies have Mongolian spots at a frequency of 96%.
Central Americans indigenous children were subjected to racism due to their Mongolian spots but progressive circles began to make having the Mongolian spot popular after the late 1960s.
Highland Peruvians have the Mongolian spot.
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 people in Hidalgo, Mexico, 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 Eskimo.
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, mainly based in Copenhagen. In 1849 he wrote of the "mixed" babies he had delivered at the lying-in hospital. He also says that "the observation made for the first time by Saabye about Eskimo 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-Eskimo population of West Greenland. Soren Hansen confirmed this, and further hypothesised that in both Japan and Greenland the spot might indicate an African connection ("a sign of direct descent from a black racial element"). (See Historical race concepts.) A missionary in Bethel, Alaska, a traditional gathering place of Yup'ik people, reported that the spots were common on children. Rudolf Trebitsh, 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 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 Journal of Cutaneous Diseases Including Syphilis, Volume 23 contained several accounts of the Mongolian spot on children in the Americas:
Holm ("Ethnological Sketch. Communications on Greenland," X., Copenhagen, 1887) announced the presence of the spot in the east part of Greenland. Bartels ("The So-Called 'Mongolian' Spots on Infants of Esquimaux," Ethnologic Review, 1903) received letters regarding it from East Greenland and also from Esquimaux of Alaska. In half-breed European-Esquimaux, Hansen says he has encountered it. Among Indians of North Vancouver, British Columbia, there are observations made by Baelz as well as by Tenkate (secondhand). In the Mayas of Central America, Starr's (Data on the Ethnography of Western Mexico, Part H., 1902) facts are corroborated by Herman (Aparecimiento de la Mancha Mongolica. Revista de Ethnologia, 1904). He cites A. F. Chamberlain (Pigmentary Spots, American Anthropologist, 1902,) and Starr (Sacral Spots of Mayan Indians, Science, New Series, xvii., 1903).
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 red men), and is remarkable by its littleness. Mayan half-breed infants do not have it (red men and Spanish white). The mulberry colored spot is very well known in Negroid Brazil. Among individuals of mixed Indian blood (black and red) it is called "genipapo" from its resemblance in color (bluish-gray) to an indigenous fruit of Brazil, named genipapo (an Indian word adopted into Portuguese).
Tem genipapo means the same as "he is of colored (negro) race." Brazilians say that the spot has a great tendency to preserve itself through the generations by inheritance, and that "Indian blood" is never lost when entering a new. This is the explanation made by those in whose family it occurs. It is rather like the Minorcan blood of the Dr. Trumbull negroes of St. Augustine, Florida, among whom this same spot shows itself even to-day. Yet no one knows them to be black, except that a dark child is sometimes born and strangled by the beautiful women of that race descended from the old Negress of Spain, whom Dr. Trumbull married and brought to America with him. Dr. Lehmann-Nitsche (Mancha Morada de los recien Nacidos, La Semana Medico, 1904) has known of cases of the spot among very swarthy individuals of Europe. He believes that the religious Brazilians are wrong in their accusation that it is the "Seal of Cain" ("Cain's seal was on the forehead. Besides, a tribal tattooing in all probability was Cain's seal, as every anthropologist might explain").
A marriage between a Chinese man and a white Mexican woman was recorded in Current Anthropological Literature, published in 1912, titled "Note on two children born to a Chinese and a Mexican white" (Note sur deux enfants nés d'un chinois et d'une mexicaine de race blanche). "Treats briefly of Chen Tean (of Hong Kong), his wife, Inez Mancha (a white Mexican), married in 1907, and their children, a boy (born April 14, 1908) and a girl (born September 24, 1909). The boy is of marked Chinese type, the girl much more European. No Mongolian spots were noticed at birth. Both children were born with red cheeks. Neither has ever been sick. The boy began to walk at ten months, the girl a little after a year."
The Mongolian spot is referred to in the Japanese idiom shiri ga aoi (尻が青い), meaning "to have a blue butt", which is a reference to immaturity or inexperience. In central Mexico, The expression is used in the same way, being locally referred to as the "green butt" (Spanish: rabo verde). It is also referred to as la patada de Cuauhtémoc, meaning "Cuauhtémoc's kick". The mark is also common among Maya people of the Yucatan Peninsula  where is referred to as Wa in Maya, wich means "circle". Korean mythology explains the spot as a bruise formed when Samshin halmi (Korean: 삼신할미), a shaman spirit to whom people pray around childbirth, slapped the baby's behind to hasten the baby to quickly get out from his or her mother's womb.
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- 尻 (Japanese)
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