Born With a Giant, Raised Birthmark Covering Her Scalp, This 7-Year-Old Girl Underwent a Remarkable Surgery

When a seven-year-old girl in China arrived for specialist treatment, a large, unusual growth covered the top and back of her scalp. Raised, folded, and shaped almost like a beret, the growth was far more than an ordinary birthmark.

The girl had a giant congenital melanocytic nevus, a condition in which pigment-producing cells form an unusually large birthmark that is present from birth. Her lesion measured approximately 11 by 13 centimeters, creating a striking appearance that required careful medical evaluation.

Doctors at a specialist dermatology hospital in China developed a surgical plan to remove the lesion in one operation and reconstruct the affected area. The procedure was successful, and follow-up examinations showed that the reconstructed skin had healed well.

A Birthmark Unlike an Ordinary Mole

Congenital melanocytic nevi are pigmented skin lesions that develop before birth. They can vary considerably in size, from small moles to extensive birthmarks covering large areas of the body.

In this girl’s case, the lesion covered the vertex and occipital regions—the top and back of her scalp. It was raised and nodular, with deep folds that gave it a distinctive beret-like shape.

The surface showed mild scaling, although doctors did not observe ulceration or bleeding. They also noted enlarged lymph nodes behind the ear, prompting further investigation.

Large congenital melanocytic nevi require medical assessment because some carry an increased risk of melanoma. Their size, location, appearance, and any changes over time help doctors determine the appropriate management.

Careful Planning Before Surgery

Before operating, the medical team performed computed tomography angiography, an imaging examination that helps map blood vessels. The scans allowed the doctors to understand the lesion’s blood supply and plan how to remove it safely.

Imaging also showed that the underlying skull bone was not involved. This was an important finding because the lesion’s raised, folded appearance could otherwise make the extent of the abnormality difficult to assess from the skin surface alone.

The team needed to remove the lesion while ensuring that the resulting wound could be covered effectively. Because the birthmark occupied a substantial area of the scalp, simply closing the wound would not have been straightforward.

Removing the Lesion in One Operation

The surgeons completely excised the giant birthmark. To reconstruct the area left behind, they used a full-thickness skin graft—a piece of skin containing both the outer skin layer and the full thickness of the dermis.

This approach allowed the doctors to remove the lesion and cover the surgical defect in a single stage. It also avoided a longer treatment process involving tissue expansion or multiple reconstructive procedures.

After surgery, the graft showed good blood supply and healed without reported complications. The operation achieved the immediate goal of removing the lesion and providing durable skin coverage.

A Lymph Node Finding That Needed Careful Interpretation

The enlarged lymph node behind the girl’s ear was another important part of her medical assessment. In patients with large pigmented lesions, changes in lymph nodes can sometimes raise concern about the possibility of cancer spread.

However, examination of the tissue showed a benign nodal nevus—a collection of pigment-producing cells within a lymph node. This is a recognized finding that can sometimes resemble metastatic melanoma under examination.

The distinction was important. The pathological findings confirmed the congenital melanocytic nevus and identified the lymph-node finding as benign, rather than evidence of melanoma spreading to the node.

Encouraging Results at Follow-Up

At the 10-month follow-up, the skin graft remained fully viable, with a satisfactory cosmetic result. Doctors also reported no evidence that the birthmark had returned at the treated site.

These findings were encouraging for the young patient. Nevertheless, removing a giant congenital melanocytic nevus does not eliminate every possible future skin-health concern. Continued medical follow-up remains important, guided by the child’s doctors.

The case also demonstrates why unusual birthmarks should be assessed carefully. A large lesion may look alarming, but imaging, surgery, and laboratory examination are needed to determine its nature and the safest course of treatment.

For this seven-year-old girl, the operation offered a successful result: the lesion was removed, the scalp was reconstructed, and the graft remained healthy during follow-up.

Source: Balkan Medical Journal, July 2026, clinical image report from specialists at the Chinese Academy of Medical Sciences and Peking Union Medical College.