Say What?

Congenital Melanocytic Nevus. Now, that's a mouthful! "Freckle" is so much easier to say :o) We are all familiar with a freckle; some of us have lots of them and you wear them with pride, or for others it's a matter of getting used to them on your skin. Those with freckles are not usually born with them; they appear on the skin over time as the individual grows. Freckles also are more pronounced when basking in the sun, thinking here of the very cute smattering of freckles on the nose and cheeks on little kids after the summer holidays. So we know about freckles.

But then, here comes along a darling little girl and people say "what is THAT on her face?" A congenital melanocytic nevus, we reply (sometimes). A what??! Let me try to explain what a CMN is and answer some questions that I know you may have. And if I do not answer your question, don't hesitate to ask it in the comments and I will do my best to answer it. I'd rather these questions asked of us without little ears around as she is proving more and more to be a sponge.

So here goes:
Congenital - means present at birth or within the first few months

Melanocytic - means that it is pigment-based; melanin is found in pigment, which is all through the skin; in Keziah's case, some of the melanin collected together, which resulted in a mole

Nevus - birthmark

Some CMN are small, large, or giant. What Keziah has is considered 'large'. Hers covers a part of her cheek, forehead and goes to the back of her head, all on her left side. Small CMN are common and you may even have one or two. When it gets to be large, it is more rare. So rare that many of us have never seen it before. We've seen port wine stains and other red birthmarks that are known as strawberries. But a large CMN is rare, happening in approx. 1 out of every 20,000 births (we were told 1 out of 500,000 but in research we also found 1/20,000).

A CMN is NOT hereditary or based on race, although, we do joke, saying that it shows Keziah's race in the fact that she is 1/8 African American......it just got all put in one spot :o) (sometimes you just need to take a lightheartedness view when dealing with things). A CMN forms usually within the first 8-12 weeks of gestation. It is not visible on a regular ultrasound. I have her ultrasound pictures and in no way can you see it. Maybe on a 3D ultrasound, I am not sure, but definitely not on a regular one. A CMN can appear anywhere on the skin (if you so choose to do so, you can always look it up on google images. Just be prepared and don't have little ones around as some pictures are pretty graphic); it does not matter the gender either.

A nevus is much more complicated than it just being a darker colour. If you look close at Kez, you will see hair growing on it, and tonnes of it. Actually, if I let it grow, it'll cover the whole part on her face with such dark coarse hair, that it'll look like a rug. The hair on her head that comes out of the nevus is also very coarse and has a mind of its own; which is why she often has braids or fancy hair-dos in, just to keep the hair on the left side contained.

(See? Like I said, hard to tame, but oh so hilarious!)


(here you can see the ponytails are different. To this day, the hair on her left is a LOT thicker than everywhere else. But nevermind the hair, check out the sparkle in those eyes!!)

As for the hair on her face, I cut it with blunt scissors. I've had to do this since her birth. It was all going well until about 2 months ago. The last two months it has not been fun. She fights me, crying, and screaming. Nathan has to help hold her down. Like I said, not fun. Before she reacted this way, I was cutting it every 3 days (it grows SO fast); now I do it once a week.

Another way that it is different than just the colour is that underneath the skin of the freckle, there is no fat, which means no padding. So when she bonks her freckle, it can hurt! Keziah's nevus is thin except by her eyebrow. There, it is bumpy with small folds of skin.

When Keziah was born, she had an MRI to make sure the birthmark was just skin deep and did not go into the brain or spinal chord, as that can sometimes be the case. Thankfully, it was only on the skin. Some people who have CMN also have what is known as 'satelites'. These are small CMN that are all over the body. Keziah also does not have this.

When we say/read the word 'melanocytic', we are reminded of the skin cancer melanoma. If you have moles, you will know the precautions that are needed to care for, watch and the importance of bringing any changes to them to your doctor, which may result in removal of the moles. This is all done because of melanoma. Those who have CMN, have a slight higher risk in getting melanoma. Those who have it on their torsos are at a higher risk than those who have it on their heads/faces (not sure why). Because Keziah has it on her face and head there is a 2%-5% higher risk of her getting melanoma later in life.

And so we watch her freckle for any changes. There have been a few. One change is that if you know her now, you will know that the CMN goes around her eye and onto her cheek. If you look at her newborn pictures, it is very, very faint, whereas now it is a lot darker. The part that is in her hair and behind her ears has lightened up a fair bit, to almost a reddish/brown colour.

After having consulted with a number of doctors, surgeons and dermatologists, we have come to the conclusion that to remove it (most of it) needs to be done. Next week, before she goes in, I'll write up a post as to exactly what the plan is and how they will go about removing it.

And for you dear readers, be prepared for a medical test on all this jargon a week after next. :o)