History Questions for an 8-Year-Old with a Changing Congenital Mole
For this 8-year-old with a congenital mole that is growing, becoming raised, and developing a darker center, you must obtain a detailed history focusing on specific changes that indicate potential malignant transformation, as these features warrant urgent evaluation and possible excision. 1
Essential History Questions About the Lesion Changes
Temporal Characteristics
- Duration of the lesion: Confirm this mole has been present since birth (congenital) versus acquired 1
- When did the changes begin? Specifically document when the growth, elevation, and darkening started 1
- Rate of change: Is the growth rapid or gradual over the past months? 1
Specific Changes to Document
- Size changes: Has the mole increased in diameter? By how much? 1
- Color changes: Document the darker center specifically—are there now three or more colors present? 1
- Shape changes: Has the mole lost its symmetry or developed irregular borders? 1
- Elevation changes: When did it become raised? Is there a nodule or lump developing? 1
Associated Symptoms
- Itching: Is the mole itchy? 1
- Bleeding: Has there been any bleeding, even minor? 1
- Pain or tenderness: Any discomfort when touching the lesion? 1
- Ulceration: Any breakdown of the skin surface? 1
Risk Stratification Questions
Characteristics of the Congenital Nevus
- Original size at birth: What was the projected adult size? Small (<1.5 cm), medium (1.5-20 cm), large (20-40 cm), or giant (>40 cm)? 1
- Satellite lesions: Are there other smaller moles around this main lesion? If yes, how many? (≥10 satellites increases melanoma risk) 1
- Surface features: Has the mole always had hair (hypertrichosis) or a rough texture (rugosity)? 1
- Color heterogeneity: Has the mole always had multiple colors or is this new? 1
Family and Personal History
- Family history of melanoma: Does anyone in the immediate family (mother, father, siblings) have melanoma? 1
- Family history of pancreatic cancer: This is associated with familial melanoma syndromes 1
- Other congenital nevi: Does the child have multiple congenital moles? 1
- Previous skin biopsies or excisions: Any prior procedures on this or other moles? 1
Neurological Symptoms (for Neural Melanosis Risk)
- Headaches: Any new or persistent headaches? 1
- Seizures: Any seizure activity? 1
- Developmental concerns: Any developmental delays or regression? 1
- Motor or sensory changes: Any weakness, numbness, or coordination problems? 1
Sun Exposure and Skin Care History
- Sun exposure patterns: Time spent outdoors, use of sun protection 1
- Sunburn history: Any blistering sunburns, especially in early childhood? 1
- Current skin care: How is the mole being monitored at home? 1
Psychosocial Considerations
- Child's awareness and concerns: Is the child bothered by the mole's appearance or changes? 1
- Parental concerns: What are the parents most worried about? 1
- Impact on activities: Does the mole location affect clothing choices or activities? 1
Critical Clinical Context
This presentation is concerning because: The combination of growth, elevation, and darkening in a congenital nevus meets multiple criteria for urgent referral according to UK melanoma guidelines—specifically "a long-standing mole which is changing in shape, colour or size" and "any mole which has three or more colours." 1
The child's age matters: While melanoma in congenital nevi typically occurs in early childhood (often before age 5) or not until adulthood, any concerning changes require prompt evaluation regardless of age. 1 The fact that this child is 8 years old and experiencing these changes warrants immediate dermatology referral with consideration for excisional biopsy. 1
Do not delay: These lesions should not be removed in primary care—they require specialist evaluation with dermoscopy and likely excisional biopsy for clinicopathological correlation. 1