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Big Mole with Even Bigger Immunity

A 4-year-old girl came to our clinic with a mole she was born with (a congenital melanocytic nevus). Over time, her parents noticed a light ring of skin around the mole. Soon after, new white patches began to show up on her face, chest, and arms—far away from the original mole.
This is a condition called vitiligo associated with a congenital mole. The body’s immune system, which normally protects us, can sometimes become overactive and start attacking the pigment cells that give our skin color. This can cause:

A halo of pale skin around a mole (halo nevus)
Larger areas of white skin patches (vitiligo)

In select cases, the nevus can behave like a “switch,” potentially triggering pigment loss at distant sites; for that reason, excision is sometimes performed, to stop the ongoing pigment loss.

Classification of Congenital Nevi

Doctors group these birthmark moles by their size as a child grows:

Small: less than 1.5 cm
Medium: 1.5–20 cm
Large/Giant: more than 20 cm across

Risk of Skin Cancer

Small and medium moles have a very low lifetime risk of developing into melanoma (well under 1%).
Large or giant moles carry a higher risk, sometimes estimated at 5–10%, and need closer medical follow-up.
Any sudden change in the mole—like rapid growth, color changes, or bleeding—should be evaluated right away.

What Can Be Done?

Treatment depends on the child, the size of the mole, and how widespread the white patches are. Options include:

Watchful waiting – many halo moles are harmless and just need monitoring.
Sun protection – sunscreen, hats, and protective clothing help reduce contrast between normal and white skin and protect the mole.
Prescription treatment for vitiligo patches – mild to potent steroids or non-steroid anti-inflammatory prescription creams may help bring color back to the white spots.
Light therapy – targeted light treatments can sometimes encourage igmentation of the white areas.
Surgery – if the mole is concerning cosmetically, or thought to be the “switch,” it can be surgically removed.
Camouflage and support – skin-colored makeup can help blend patches, and counseling can help children feel confident.

FAQs for Families

Is the halo around the mole dangerous?

In most children, it’s a harmless immune reaction. Still, regular check-ups are important.

Will the white patches go away?

Sometimes they stabilize, and with treatment, some may regain pigment.

Does removing the mole cure vitiligo?

Not always. In some cases it helps, but vitiligo can still appear elsewhere because the immune system and its attacks on pigment producing cells called melanocytes have been activated.

What’s the cancer risk?

It depends on mole size. Small and medium moles have very low risk. Large or giant moles carry a higher, but still uncommon, risk and require close monitoring.

How can we help our child cope?

Sun protection, camouflage makeup, and emotional support make a big difference. Most importantly, reassurance that their skin condition doesn’t define who they are.

Disclaimer: This case features an actual patient of Dermatology Solutions, shared for educational purposes with written patient consent. All patient images and content are protected under copyright. Reproduction, copying, or distribution without explicit written consent from Dermatology Solutions is strictly prohibited.

Reference: Stierman, S. C., Tierney, E. P., & Shwayder, T. A. (2009). Halo congenital nevocellular nevi associated with extralesional vitiligo: A case series with review of the literature. Pediatric Dermatology, 26(4), 414–424. https://doi.org/10.1111/j.1525-1470.2009.00938.x