Counsel a parent on their newborn's large congenital melanocytic naevus — OSCE

Communication framework

Establish what the mother already understands and feels. Ask her to tell you, in her own words, what she has been told and what she is most worried about. The fear that the lesion means her daughter will get cancer, the wish to have it removed straight away so the cancer cannot happen, and the worry about how it will look as her daughter grows up are the three things you will spend the most time addressing. Address them with the plain language and with the reassurance of the realistic plan. Do not minimise her worry — name it, and relieve it with the facts. [1]

Explain the lesion in the plain language, without jargon. Tell her that her daughter was born with a type of birthmark called a congenital melanocytic naevus, a patch of skin where the pigment cells gathered together before birth. It is larger than the common small mole, and the smaller spots around it are the satellite spots of the same birthmark. It is not a cancer, it is not something she did or did not do during the pregnancy, and it is not the result of an infection or a medicine. The patch will stay as her daughter grows — it will grow with her rather than fade away — and the colour and the surface may change a little over time. [10]

Address the cancer fear honestly and accurately. The honest answer is that the larger birthmark does carry a higher chance of a skin cancer called melanoma than the small mole, and that is why her daughter will be looked after by the specialist team rather than just the general practitioner. But it is not a certainty, and the role of the specialist team is to watch the birthmark closely so that if a change does happen, it is caught early. Most children with this birthmark do not develop melanoma, and the surveillance is the early detection, not the expectation of the cancer. [1] [3]

Address the wish for the immediate removal. This is the moment to explain, gently, why the immediate surgery is not the usual recommendation. The reason is that the same pigment cells that formed the birthmark are also, in a few children, present in other places — including around the brain and the spine — and removing the patch on the back does not remove every one of those cells. So the surgery does not guarantee the cancer will not happen, and it brings the scars and the anaesthetic risk. The surgery is an option for some children, chosen for the appearance or the comfort or the difficult-to-watch spot, and it is a decision made together with the specialist team over time, not the emergency. [3] [6]

Outline the surveillance plan and the specialist referral. The plan is the referral to the specialist team that looks after children with these birthmarks. They will take the photographs and the close-up pictures (the dermoscopy) to set the baseline, and they will consider a scan of the brain and the spine because of the size and the location of the birthmark and the satellite spots. Your daughter will have the regular skin checks, and you will be taught the changes to watch for — a new lump, a change in the colour, a bleeding, or a growth within the birthmark — that should prompt the review. The sun protection is the part you can do every day. [3] [6]

Address the appearance and the psychosocial support. Acknowledge the worry about the appearance, because it is real and it matters for her daughter's confidence as she grows. Tell her that the cosmetic options — the surgery and the laser — are available and are chosen with the specialist team when the time is right, and that the support groups connect families and children with the same birthmark. Confirm the understanding by asking her to say back the plan — the specialist team, the photographs, the scan, the regular checks, and the changes to watch for — and offer the chance to ask anything else. Document the discussion, confirm the child is well and feeding normally, and discharge with the safety-net advice. The mother who leaves feeling informed, relieved of the fear, and equipped with the clear plan is the mother who partners in the surveillance and the care. [1] [3]