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]}