My cousin has scalp moles. What could be causing them?

Question

Hello doctor,

My 3-year-old cousin has a small brown mole 4 mm on his scalp (right temporal region, feels a little bit elevated and very slightly rough on top and shiny) and two very faint brownish patches of 3 mm around it (top and bottom right of the main mole; the bottom right patch feels very slightly more bumpy than the top pigmentation).

I discovered it last night, so I do not know how long it has been. He has a history of mild mastocytosis urticaria pigmentosa from age four months, which manifested as a few small freckles scattered on his left neck, some on his left arm, and on his left leg.

He is otherwise healthy and growing well. He lives in a sunny area that includes a lot of outdoor play in his preschool.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

In a 3-year-old with a history of mild urticaria pigmentosa (cutaneous mastocytosis), a newly noticed 4 mm slightly elevated, shiny, and rough brown mole on the scalp, with two nearby faint brownish patches, is most likely benign, such as a congenital or acquired melanocytic nevus, or possibly mastocytoma-related pigmentation, given his history.

However, because it is a new finding and the scalp is a sun-exposed site with a higher melanoma risk over a lifetime, it is essential to have it assessed in person by a pediatric dermatologist. They can examine it with dermoscopy to distinguish between a mole, mastocytosis lesion, or other benign growth and decide if monitoring, biopsy, or removal is needed.

In the meantime, protect the scalp from excessive sun exposure (hat or sunscreen for scalp/parting) and watch for any rapid changes in size, shape, color, surface texture, or symptoms such as bleeding or persistent itching.

For now, there is no specific home treatment until a pediatric dermatologist properly assesses the lesion. The main steps to follow are:

Keep the scalp protected from sun exposure with a hat when outdoors.
Avoid scratching or rubbing the area (as this can trigger mastocytosis spots to swell or redden).
Monitor the mole and surrounding patches for changes in size, color, texture, or symptoms such as bleeding or crusting.

If the dermatologist confirms it is a benign mole or mastocytosis lesion, it may only require regular observation. If there are suspicious features, they may recommend dermoscopic follow-up or removal.

No creams or medicines should be applied without specialist advice, as these can sometimes irritate the skin and alter the appearance of the lesion, making diagnosis harder.

I hope this helps.