Management Of Congenital Melanocytic Nevi Research Articles

Updates in the Management of Congenital Melanocytic Nevi.

Congenital melanocytic nevi (CMN) carry an increased risk of melanoma and may be disfiguring, and consensus regarding treatment recommendations is lacking. While clinical monitoring is the standard of care, many caregivers are interested in its removal to prevent psychosocial burden or to decrease risk. Although melanoma can occur regardless of CMN removal, there are a variety of treatments that may offer improved cosmesis or local symptom control, including surgical excision, laser therapy, and other superficially destructive techniques. Regardless of the selected management, these patients are monitored for ongoing melanoma risk. An extensive discussion with families regarding the risks and benefits of observation versus active intervention is essential. To facilitate these discussions, we herein summarize current CMN management strategies and considerations.

Surgical treatment of children and youth with congenital melanocytic nevi: self- and proxy-reported opinions.

The role of surgery in the management of congenital melanocytic nevi (CMN) is controversial. Data on surgical outcomes and predictors of satisfaction remain scarce. An online survey was employed following worldwide recruitment of youth aged 14-25years (n = 44) and parents of children ≤ 18years (n = 249) with CMN to query patterns of treatment and satisfaction with and opinions about the benefits of surgery. In proxy-reports, 121 of 249 (49%) and in self-reports 30 of 44 (75%) participants underwent CMN excision. The most common reasons for surgery were psychosocial determinants, aesthetic improvement, and melanoma risk reduction. The overall satisfaction with surgical management was good, although no predictors for satisfaction could be identified. Higher current age of the child was found to predict decision regret in proxy-reports. Most participants indicated that having a scar is more socially acceptable than a CMN. Opinions differed on whether surgery should be deferred until the child is old enough to be involved in the decision-making process. Whether and when to perform surgery in children with CMN is a multifaceted question. Awareness of common concerns as well as risks and benefits of surgery are essential to ensure critical reflection and balanced decision-making.

Management of Congenital Melanocytic Nevus on Face Using Multiple Re-expansion Method: Aesthetic and Psychosocial Results.

Congenital giant melanocytic nevus on the face is a challenging condition, especially in the pediatric population. It can produce significant cosmetic deformity with negative psychosocial effects in pediatric patients even after treatment. The objective of this study was to report aesthetic and psychosocial results in the management of congenital melanocytic nevus on the face using multiple reexpansion. Data of 6 patients with congenital melanocytic nevus on the face who underwent excision and multiple reexpansion at our center from September 2004 to August 2017, were retrospectively reviewed. To evaluate aesthetic outcomes, preoperative and final photographs of each patient were reviewed by 3 other plastic surgeons and 4 laypersons. For comparison, 6 other patients who were treated with conventional surgery during the same period were reviewed. After final reconstruction surgery, the authors surveyed patients' satisfaction via telephone. Six patients were followed up for an average of 87.66 months (range, 55-123 months). The mean number of tissue expander insertions was 3.33 and the mean number of total expanders inserted was 4.83. Complication associated with expander exposure occurred in 1 patient during the fifth expansion. The average score of aesthetic outcome in the multiple reexpansion group was superior to that of the conventional group (2.60 versus 2.10, P = 0.03). During the telephone survey, patients did not rate their appearance as positive, although they were comparatively satisfied with the surgical procedure. Considering the low rate of malignancy involving congenital melanocytic nevus in childhood, multiple reexpansion is an attractive option to obtain better results compared with other reconstructive methods.

Management of congenital melanocytic nevi in the plastic surgery clinic: Families' expectations and their persistent concern about malignancy.

Children with congenital melanocytic nevi (CMN) were historically managed with surgical removal to lower the risk of malignant transformation. The evolving literature over the last decade has indicated a significantly lower risk than previously estimated. Indications for excision currently revolve around aesthetic and psychosocial concerns. This study describes and evaluates the perspectives and expectations of patients and families referred to a pediatric plastic surgery clinic on CMN management. A two-part questionnaire was administered before and after an initial clinic appointment to evaluate patient and family concerns of lesion growth, risk of malignancy, treatment expectations, and stigmatization. Thirty questionnaires were completed for 11 male and 19 female patients, mean age 9.2years (1-25). Referring doctors (majority dermatologists) were rarely concerned about malignancy (8%), but parents listed it as a top reason for wanting the CMN removed (37%) and the most common expectation for the visit followed by information about surgical options and outcome. Before the clinic, 93% were at least "slightly" worried about CMN growth and 96% about malignancy, whereas 63% and 72%, respectively, after the clinic. Families want information about surgical excision and are concerned about malignancy, indicating lingering misinformation or misconception about melanoma risk. For the majority, CMN removal remains at least slightly important, presumably for aesthetic reasons and remaining concern about malignancy. Involved health care professionals should assure reliable and coherent patient information about MM risk, indications for surgery and expected outcome to best support families' decision-making.

Abstract: Age, Socioeconomic Status, Race, and Congenital Nevus Excision

BACKGROUND: Excision of congenital nevi is recommended for cosmetic1 benefit, as well as for malignancy prophylaxis.2,3,4 As the lesions grow with the children, excisions at a younger age may be technically easier. The authors examined patterns in congenital nevus excision. METHODS: HCUP-KID, the largest publicly-available pediatric inpatient all-payer database, was queried for patients with diagnoses of congenital nevi and procedure codes indicating excisions between 2000–2012. Regression models were used, with significance <0.05. RESULTS: One thousand three hundred and six discharges were found, of patients of average age 5.2 ± 5.2 years. Six hundred seventy-seven patients (53.7%) were female; 54.9% were Caucasian. Using a linear model to predict age, controlling for gender, race, private insurance, high income quartile, and hospital region, white race (-1.53 years, p<0.0001) and median household income in the highest quartile (-0.96 years, p=0.044) were significant. In binary logistic regressions controlling for gender, race, private insurance, high-income quartile, and region, increasing age was associated with fewer local excisions (OR 0.97, 0.94–0.99) and less tissue expander use (OR 0.96, 0.92–0.99) and more radical excisions (OR 1.05, 1.02–1.08) and graft use (OR 1.07, 1.04–1.10). Forty-four patients had complications, including 29 infections and 12 hemorrhages/hematomas. In a binary logistic regression controlling for gender, race, private insurance, region, excision type, age, and zip-code income quartile, local and radical excision were less likely to be associated with complications versus tissue expanders, flaps, and grafts (OR 0.11, 0.03–0.45 and OR 0.19, 0.04–0.85, respectively). Southern location was associated with complications (OR 5.15, 1.23–20.69). There were zero complications in the northeastern region versus 27 in the south and 13 in the west. Patients with complications had longer hospital stays (6.18 ± 8.05 versus 1.88 ± 2.14, p <0.001) and higher hospital charges ($43,662.08 ± 61,214.37 versus $19,777.82 ± 16,516.34, p <0.001). CONCLUSIONS: Patient age at presentation drives selection of excision type for congenital nevi. Certain excision types are higher risk. As patient age at presentation is associated with socioeconomic and demographic factors, non-white and poorer patients may be at increased risk for complications following excision of congenital nevi. This study was limited by the lack of lesion size information available in the database; however it is the first study to examine management of congenital melanocytic nevi on a national scale. REFERENCES: 1 Masnari O, Landolt MA, Roessler J et al. Self- and parent-perceived stigmatization in children and adolescents with congenital or acquired facial differences. J Plast Reconstr Aesthet Surg. 2012;65: 1664–70. doi: 10.1016/j.bjps.2012.06.004. 2 Arneja JS, Gosain AK. Giant congenital melanocytic nevi. Plast Reconstr Surg. 2009; 124: 1-13e. doi: 10.1097/PRS.0b013e3181ab11be. 3 Marghoob AA, Schoenbach SP, Kopf AW, Orlow SJ, Nossa R, Bart RS. Large congenital melanocytic nevi and the risk for the development of malignant lemanoma: A prospective study. Arch Dermatol. 1996;132: 170–5. 4 Tannous ZS, Mihm MC, Sober AJ, Duncan LM. Congenital melanocytic nevi: Clinical and histopathologic features, risk of melanoma, and clinical management. J Am Acad Dermatol. 2005;52: 197–203.

Congenital melanocytic nevi: update in genetics and management.

The article intends to review recent updates in the management of congenital melanocytic nevi (CMN) and the evolving genomic landscape that has begun to shed light on the nature of nevogenesis, malignant potential, and possible therapeutic targets for those with melanoma and neurologic involvement. CMN are the result of postzygotic somatic mutations involving key proteins in the mitogen-activated protein kinase pathway, primarily NRAS and BRAF. Complications include a spectrum of neurologic findings and development of melanoma. Patients with extracutaneous involvement may be better termed as having 'CMN syndrome'. MRI findings in high risk patients with multiple CMN may best predict clinical outcome. The management of patients with CMN is complex. Neurologic involvement and melanoma remain the two most devastating complications. New, genetically targeted therapies for patients with complications may be of value, and research for potential therapies is ongoing.

The Shifting Paradigm in the Management of Giant Congenital Melanocytic Nevi

Congenital melanocytic nevi remain a subject of controversy with respect to risk of malignant transformation and recommended management. Recent studies indicate a lower malignant risk (0.7 to 2.9 percent) than had previously been estimated. Surgery has not been proven to reduce malignant risk or improve quality of life, and may result in undesirable aesthetic and functional outcomes. In this article, the authors review key controversial issues in the management of congenital melanocytic nevi and re-evaluate indications for surgical treatment. An updated review of controversial topics in the management of congenital melanocytic nevi is presented, and clinical applications are demonstrated through clinical cases. Updates regarding the risks and outcomes of congenital melanocytic nevi patients open a renewed debate with respect to the indications for surgery as well as the extent of surgery that may be suitable. Treatment should be tailored to achieve optimal aesthetic results whereby complete nevus excision is not the goal. As such, nonsurgical management and incomplete nevus excision should be integrated as legitimate parts of any treatment algorithm.

Últimos datos sobre el riesgo de malignización de los nevus melanocíticos congénitos: el debate sobre el tratamiento continúa

Congenital melanocytic nevi (CMN) have traditionally been considered a risk factor for the appearance of melanoma, but the true incidence of malignancy is unknown. Although various studies have attempted to quantify it, the results are highly variable and it is difficult to decide on the best therapeutic approach to take. Consequently, for some time the management of CMN has depended more on personal experience than on clear scientific evidence. The most recent studies performed in large patient series indicate that the risk of malignancy in CMN is much lower than expected and mainly affects large lesions involving the axial midline. In addition, it appears that a number of melanomas develop on the site of partially or completely excised lesions, or even away from the CMN itself, making the appropriateness of prophylactic surgery increasingly doubtful.

Recent Data on the Risk of Malignancy in Congenital Melanocytic Nevi: The Continuing Debate on Treatment

Congenital melanocytic nevi (CMN) have traditionally been considered a risk factor for the appearance of melanoma, but the true incidence of malignancy is unknown. Although various studies have attempted to quantify it, the results are highly variable and it is difficult to decide on the best therapeutic approach to take. Consequently, for some time the management of CMN has depended more on personal experience than on clear scientific evidence. The most recent studies performed in large patient series indicate that the risk of malignancy in CMN is much lower than expected and mainly affects large lesions involving the axial midline. In addition, it appears that a number of melanomas develop on the site of partially or completely excised lesions, or even away from the CMN itself, making the appropriateness of prophylactic surgery increasingly doubtful.

Pigmented Lesions in Children

Pigmented lesions in childhood can pose significant diagnostic and therapeutic challenges. This article examines the most common pigmented lesions encountered in childhood. Special emphasis is placed on the diagnosis and management of congenital melanocytic nevi, acquired melanocytic nevi, clonal nevi, halo nevi, atypical melanocytic nevi, Spitz nevi, recurrent nevi, childhood melanoma, blue nevi, speckled lentiginous nevi, and other melanocytic nevi such as nevus of Ota and nevus of Ito. Proper diagnosis and an understanding of the natural history of pigmented lesions in children are essential for successful outcomes.

Staged Management of a Congenital Nevus of the Breast and Abdomen Presenting in a Female Infant

The management of congenital melanocytic nevi is controversial. The authors describe their management of a congenital nevus covering the breast and abdomen of a one-month-old girl over a 16-year period. To prevent damage to the developing breast, a staged approach was used. The nevus over the abdomen was resected first at six years of age and the remaining portion was removed after breast development was complete at 16 years of age. The breast defect was resurfaced with a full thickness skin graft from the groin. The patient was pleased with the postoperative result. This staged approach allowed an optimized aesthetic result.

The Place of Laser Treatment in the Management of Congenital Melanocytic Nevi

Shipkov, Christo Dimitrov MD, PhD; Anastassov, Youri Konstantinov MD, PhD; Yonkov, Alesander MD, PhD Author Information

Congenital Nevus: The Indiana University??s Approach to Treatment

The article will review the different treatment modalities for congenital nevi and the senior author's approach to these lesions. The management of congenital melanocytic nevus presents a diagnostic dilemma. Treatment must weigh the risk of malignancy, psychological distress to parents and child, and potential morbidities of excision. Excision of every nevus is neither applicable nor practical. Most plastic surgeons would agree that a large nevus mandates excision because of the risk of malignancy. However, debates occur regarding treatment of small and medium size nevi. Opinions differ regarding the types of reconstruction, malignant potential, and psychological impact of leaving a lesion untreated.

The management of congenital melanocytic nevi

The management of congenital melanocytic nevi (CMN) has become a controversial subject. Since the studies of Greeley et al,¹it has become apparent that patients with giant ("bathing trunk" and others) nevi have a relatively increased incidence of malignant melanoma developing in their lesions. Now the subject of debate has been enlarged to include all CMN. I stress the term "congenital" because CMN occur at a much earlier time in development than nevi appearing after birth. The presence of such lesions on the upper and lower eyelids (the "wink" nevus) suggests that they may be formed between 50 and 53 days of embryologic age. Furthermore, some dermatopathologists²believe CMN are histologically distinct from lesions developing after birth. At least two issues remain to be resolved. Can CMN be classified by size (or any other way) into those that should be removed and those that may be safely left

The Management of Congenital Melanocytic Nevi

The management of melanocytic nevi (CMN) has become a controversial subject. Since the studies of Greeley et al, 1 it has become apparent that patients with giant (bathing trunk and others) nevi have a relatively increased incidence of malignant melanoma developing in their lesions. Now the subject of debate has been enlarged to include all CMN. I stress the term congenital because CMN occur at a much earlier time in development than nevi appearing after birth. The presence of such lesions on the upper and lower eyelids (the wink nevus) suggests that they may be formed between 50 and 53 days of embryologic age. Furthermore, some dermatopathologists 2 believe CMN are histologically distinct from lesions developing after birth. At least two issues remain to be resolved. Can CMN be classified by size (or any other way) into those that should be removed and those that may be safely left