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Surgical management of giant congenital melanocytic nevus of face in the adult—outcomes and experience

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Congenital melanocytic nevi (CMN), especially those of the face, cause great psychological stress to the patient. Giant-sized lesions coupled with the complex anatomy and functional demands of the region complicate treatment, more so in adults. We present our outcomes and our experience in the treatment of such lesions in the adult.

Methods

A retrospective review was carried out of all patients over the age of 14 years undergoing surgical treatment for giant CMN of the face at a tertiary care hospital. This three-year study focuses on nevi of the face; nevi elsewhere are not included. Surgical techniques employed, and complications and esthetic outcome are discussed.

Results

Seventeen patients were included in the study. Primary reconstructive procedures included tissue expansion (TE), split-thickness skin graft (STSG), full-thickness skin graft (FTSG), and free tissue transfer (FTT). Additionally, secondary procedures were required in 15 patients. Esthetic outcomes were superior with TE and FTT.

Conclusions

Size and location of the lesion, and compliance of the patient are the primary determinants of the choice of procedure. However, potential for malignant transformation and optimal esthetic results have to be also borne in mind. Treatment should be prompt, reconstruction should be individualized and follow-up should be prolonged.

Level of Evidence: Level IV, therapeutic study.

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References

  1. Walton RG, Jacobs AH, Cox AJ (1976) Pigmented lesions in newborn infants. Br J Dermatol 95:389–396

    Article  CAS  Google Scholar 

  2. Ingordo V, Gentile C, Iannazzone SS, Csano F, Naldi L (2007) Congenital melanocytic nevus: an epidemiologic study in Italy. Dermatology 214:227–230

    Article  Google Scholar 

  3. Haupt HM, Stern JB (1995) Pagetoid melanocytosis. Histologic features in benign and malignant lesions. Am J Surg Pathol 19:792–797

    Article  CAS  Google Scholar 

  4. Castilla EE, da Graca DM, Orioli-Parreiras IM (1981) Epidemiology of congenital pigmented naevi: I. Incidence rates and relative frequencies. Br J Dermatol 104:307–315

    Article  CAS  Google Scholar 

  5. Quaba AA, Wallace AF (1986) The incidence of malignant melanoma (0 to 15 years of age) arising in “large” congenital nevocellular nevi. Plast Reconstr Surg 78(2):174–181

    Article  CAS  Google Scholar 

  6. Marghoob AA, Bittencourt FV, Kopf AW, Bart RS (2000) Large congenital melanocytic nevi. Curr Probl Dermatol 12:146–152

    Article  Google Scholar 

  7. Ka VS, Dusza SW, Halpern AC, Marghoob AA (2005) The association between large congenital melanocytic naevi and cutaneous melanoma: preliminary findings from an Internet-based registry of 379 patients. Melanoma Res 15:61–67

    Article  Google Scholar 

  8. Zaal L, Mooi W, Sillevis Smitt J, van der Horst C (2004) Classification of congenital melanocytic naevi and malignant transformation: a review of the literature. Br J Plast Surg 57:707–719

    Article  CAS  Google Scholar 

  9. Egan CL, Oliveria SA, Elenitsas R, Hanson J, Halpern AC (1998) Cutaneous melanoma risk and phenotypic changes in large congenital nevi: a follow- up study of 46 patients. J Am Acad Dermatol 39:923–932

    Article  CAS  Google Scholar 

  10. Gosain A, Santoro T, Larson D, Gingrass R (2001) Giant congenital nevi: a 20-year experience and an algorithm for their management. Plast Reconstr Surg 108(3):622–631

    Article  CAS  Google Scholar 

  11. Bauer BS, Vicari FA (1988) An approach to excision of congenital giant pigmented nevi in infancy and early childhood. Plast Reconstr Surg 82:1012–1021

    Article  CAS  Google Scholar 

  12. Leshem D, Gur E, Meilik B, Zuker R (2005) Treatment of Congenital Facial Nevi. J Craniofac Surg 16(5):897–903

    Article  Google Scholar 

  13. Grichnik JM, Rhodes AR, Sober AJ (2008) Benign neoplasias and hyperplasias of melanocytes. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Lefell DJ (eds) Fitzpatrick’s dermatology in general medicine, 7th edn. McGraw-Hill, New York, pp 1099–1122

    Google Scholar 

  14. Kincannon J, Boutzale C (1999) The physiology of pigmented nevi. Pediatrics 104:1042–1045

    CAS  PubMed  Google Scholar 

  15. Rhodes AR (1986) Melanocytic precursors of cutaneous melanoma. Estimated risks and guidelines for management. Med Clin North Am 70:3–37

  16. Marghoob AA (2002) Congenital melanocytic nevi. Evaluation and management. Dermatol Clin 20:607–616 viii

    Article  Google Scholar 

  17. Strauss RM, Newton Bishop JA (2008) Spontaneous involution of congenital melanocytic nevi of the scalp. J Am Acad Dermatol 58:508–511

    Article  Google Scholar 

  18. Kopf AW, Bart RS, Hennessey P (1979) Congenital nevocytic nevi and malignant melanomas. J Am Acad Dermatol 1:123–130

    Article  CAS  Google Scholar 

  19. Corcoran J, Bauer BS (2008) Cutaneous lesions in children. In: Bentz ML, Bauer BS, Zuker RM (eds) Principle and practice of pediatric plastic surgery. Quality Medical Publishing, St. Louis, pp 83–104

    Google Scholar 

  20. Pilney FT, Broadbent TR, Woolf RM (1967) Giant pigmented nevi of the face: Surgical management. Plast Reconstr Surg 40:469

    Article  CAS  Google Scholar 

  21. Hale E, Stein J, Ben-Porat L, Panageas K, Eichenbaum M, Marghoob A et al (2005) Association of melanoma and neurocutaneous melanocytosis with large congenital melanocytic naevi—results from the NYU-LCMN registry. Br J Dermatol 152:512–517

    Article  CAS  Google Scholar 

  22. Kinsler VA, Birley J, Atherton DJ (2009) Great Ormond Street Hospital for Children Registry for congenital melanocytic naevi: prospective study 1988–2007. Part 1- epidemiology, phenotype and outcomes. Br J Dermatol 160:143–150

    Article  CAS  Google Scholar 

  23. Bittencourt F, Marghoob A, Kopf A, Koenig K, Bart R (2000) Large congenital melanocytic nevi and the risk for development of malignant melanoma and neurocutaneous melanocytosis. Pediatrics 106:736–741

    Article  CAS  Google Scholar 

  24. Goil P, Patil A, Malhotra K, Chaudhary G (2017) Microvascular reconstruction with free fibula osteocutaneous flap in mandibular ameloblastomas—an institutional experience. Eur J Plast Surg 41(1):15–20

    Article  Google Scholar 

  25. Gogate P, Deshpande R, Chelerkar V, Deshpande S, Deshpande M (2011) Is glaucoma blindness a disease of deprivation and ignorance? A case–control study for late presentation of glaucoma in India. Indian J Ophthalmol 59(1):29–35

    Article  Google Scholar 

  26. Schwarz R, Bhai KS (2004) Reasons for late presentation of cleft deformity in Nepal. Cleft Palate Craniofac J 41(2):199–201

    Article  Google Scholar 

  27. Lim S, Ryu A, Lee D, Yoon Y (2018) Treatment of congenital divided nevus of the eyelid with excision and blepharoplasty

  28. Yap L, Earley M (2001) The panda naevus: management of synchronous upper- and lower-eyelid pigmented naevi. Br J Plast Surg 54(2):102–105

    Article  CAS  Google Scholar 

  29. Rajput GC, Mahajan D, Chaudhary KP, Deewana V (2015) Kissing naevus arising from neural crest cells presenting as upper and the lower lid mass. J Neurosci Rural Pract 6:417–419

    Article  Google Scholar 

  30. Rompel R, Möser M, Petres J (1997) Dermabrasion of congenital nevocellular nevi: Experience in 215 patients. Dermatology 194:261

    Article  CAS  Google Scholar 

  31. Zitelli JA, Grant MG, Abell E et al (1984) Histologic patterns of congenital nevocytic nevi and implications for treatment. J Am Acad Dermatol 11:402

    Article  CAS  Google Scholar 

  32. Grevelink JM, Van Leeuwen RL, Anderson RR et al (1997) Clinical and histological responses of congenital melanocytic nevi after single treatment with Q-switched lasers. Arch Dermatol 133:349

    Article  CAS  Google Scholar 

  33. Rehal B, Golshanara N, Maguina P (2011) Burn unit experience treating giant melanocytic nevi: 10-year review. J Burn Care Res 32(4):475–480

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Sawai Man Singh Medical College and Hospital, JLN Marg, Jaipur, 302004, India

    Pradeep Goil, Ayush Jain, Aditya Nanasaheb Patil, Abhimanyu Singh & Ghisulal Chaudhary

Authors
  1. Pradeep Goil
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  2. Ayush Jain
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  3. Aditya Nanasaheb Patil
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  4. Abhimanyu Singh
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  5. Ghisulal Chaudhary
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Corresponding author

Correspondence to Aditya Nanasaheb Patil.

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Conflicts of interest

Pradeep Goil, Ayush Jain, Aditya Nanasaheb Patil, Abhimanyu Singh, and Ghisulal Chaudhary declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all patients included in the study, wherever applicable. Written informed consent has also been obtained from all individuals for use of their clinical photographs in this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Goil, P., Jain, A., Patil, A.N. et al. Surgical management of giant congenital melanocytic nevus of face in the adult—outcomes and experience. Eur J Plast Surg 41, 529–534 (2018). https://doi.org/10.1007/s00238-018-1425-0

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  • DOI: https://doi.org/10.1007/s00238-018-1425-0

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