Introduction: Birth of an Harlequin fetus in an African maternity ward is an exceptional event. There is no question as to the diagnosis, but no treatment is available.
Case report: A female infant was delivered with typical lesions of malignant keratoma. Death occurred 20 hours after birth.
Discussion: In countries with adequate intensive care facilities (hydration, acitretine), such infants may occasionally survive with the risk of developing major lamellar ichthyosis which remains a handicap for the rest of life. In Burkina-Faso, such therapeutic facilities are lacking as are means of antenatal diagnosis. The ethical question as to whether or not to attempt survival measures is quite different under these conditions.