An asymptomatic brown atrophic plaque was present at birth on the back of this toddler. The development of paraspinal muscle atrophy prompted a spine magnetic resonance imaging study which revealed an intraspinal lipoma extending from L5 to the termination of the thecal sac at S2. The lipoma was successfully removed following increasing concern that the lesion was a focus of spinal cord tethering. A number of congenital lesions may be associated with spinal dysraphism or incomplete closure of the spinal canal. Although these defects are usually located in the lumbosacral area, lesions anywhere along the midline of the back should be suspect. Cutaneous markers which are associated with a high index of suspicion include hypertrichosis, large dimples, skin tags, lipomas, hemangiomas, scars, and dermal cysts or sinus tracts. Although congenital pigmented nevi are considered to be lesions of low risk, midline pigmented nevi of any size may also be associated with spinal anomalies. During the first 6 months of life ultrasound is a quick, inexpensive, reliable, non-invasive technique for screening these infants and can usually be performed before the baby leaves the newborn nursery.
6 cm round brown plaque with prominent hair and a 5 mm dark brown central papule; midline well healed scar