Rare birthmark: Charlotte’s giant congenital nevus

“GCMN can also develop into melanoma, a type of skin cancer, which might also occur in the brain and spine if there is neuro-melanosis,” he said.

Hair can also grow directly from the main GCMN or from smaller, scattered satellite moles that frequently accompany a large birthmark.

Koh said there is no single medical cure that permanently and completely erases a GCMN, as “it is a deep skin lesion that results from early embryonic genetic mutations”. However, there are several approaches to manage the condition and reduce or remove some of the lesions.

Regular dermatological monitoring is essential because there is a 3% to 11% lifetime risk of GCMN developing into melanoma, as well as potential neurological conditions.

Other methods include surgery to completely remove the mole or laser therapy to lighten its pigmentation.

Confident tomboy

Worried about how her daughter would cope with bullying, Zheng began preparing her to deal with people from a young age.

She taught Charlotte that GCMN was “nothing but a birthmark” and that if people asked about it, she should simply tell them what it was.

“And that was what she had been doing since pre-school. Of course, before she started pre-school, we informed the principal so that she could tell the teachers. By letting her tell her friends, classmates and teachers about her condition, we have helped build her strength and confidence,” Zheng said.

Her peers and teachers came to understand her condition, and Zheng said that, surprisingly, Charlotte was never bullied, not even in primary school.

“Her friends even gave her the nickname ‘spotty leopard’, which she was fine with. They stopped calling her that as they grew older,” she added.

Charlotte loves adventure and sports, especially rock climbing, and would often put her condition aside to immerse herself in her hobbies. However, she needed to avoid sunlight as much as possible.

“We were told that because of her rare condition, there was a possibility of her developing more moles elsewhere on her body, as well as an increased risk of skin cancer,” Zheng said.

Her mother also admitted that she was worried about Charlotte, who will be starting secondary school in 2027, especially as spots have appeared on her face.

Studies have shown that about three in 10 children with GCMN experience social isolation, bullying or exclusion by their peers.

“Charlotte met another child with GCMN at the Rare Skin Conditions Society – a little boy named Pin Hao – and they became fast friends. Pin Hao went for surgery to remove some of the spots on his face, and Charlotte made up her mind that she wanted to do likewise. I told her it would be painful, but she had her mind set on it,” Zheng said.

Surgery often requires multiple procedures and can leave scarring.

Koh said: “Smaller or ‘satellite’ moles often sprout in patients with giant congenital nevus. These can occur anywhere on the skin. The lesions may be removed if there is a cosmetic concern, like when they appear on the face. They can be removed by surgery or lasers.”

He added that surgery can remove the spots entirely, and there is a smaller chance of recurrence. Laser treatment is usually not recommended because of the high risk of recurrence.

Zheng said: “I hope Charlotte continues to be confident as she grows. After all, everyone is born to look different, and we should all feel beautiful in our own skin.”