This case exemplifies the difficulty in differentiating Mongolian spots and bruises in cases of suspected child abuse, particularly when they occur in regions (such as the back) that are typically associated with trauma. In the presented case, the differential diagnosis was particularly complex since the characteristics and localization of the lesions were highly suggestive of “grabbing/gripping” injuries, thus posing a significant risk of misdiagnosis. It is crucial to emphasise that Mongolian spots have been reported in atypical sites such as the back, thighs, and shoulders, sometimes even in combination with more typical locations. As they can indeed present in locations not generally considered typical, this can lead to confusion when evaluating potential child abuse cases [1,2,3,4,5]. A thorough and timely follow-up examination is necessary to distinguish between Mongolian spots and traumatic skin lesions. The persistence of Mongolian spots over time is a key diagnostic feature, as they do not undergo the typical physiological degradation process that characterises bruises and other traumatic injuries. A follow-up examination can provide essential clarity, allowing for the proper classification of skin findings. This is especially important in cases where the lesion’s appearance is ambiguous or atypical. The complexity of this diagnostic process is further compounded by the lack of awareness regarding atypical Mongolian spots. While these lesions are more commonly located in the lumbosacral region, it is vital to consider other areas of the body where they may present. This variability in localisation underscores the critical need for forensic professionals to have a comprehensive understanding of the different patterns of Mongolian spots in order to avoid misdiagnosing them as signs of physical trauma [1, 10, 11].

In conclusion, we would like to emphasise the significance of the findings and the need for continued education on the differential diagnosis of Mongolian spots, particularly in forensic medical examinations. This is essential for forensic professionals to make accurate assessments and avoid the misinterpretation of congenital pigmentation disorders as signs of child abuse. We wholeheartedly agree with the authors’ recommendation [1] for a two-step medico-legal evaluation in cases of skin discolorations in individuals with pigmented skin and the importance of photo documentation for optimal comparability and accurate diagnosis., thus representing a desirable standard in forensic practice in ensuring the identification of abuse while preventing unnecessary and harmful misdiagnoses.