Management Of Congenital Nevi Research Articles

Management of Congenital Nevi at a Dermatologic Surgical Paediatric Outpatient Clinic: Consequences of an Audit Survey 1990–1997

Management of Congenital Nevi at a Dermatologic Surgical Paediatric Outpatient Clinic: Consequences of an Audit Survey 1990–1997

Management of Congenital Nevi at a Dermatologic Surgical Paediatric Outpatient Clinic: Consequences of an Audit Survey 1990–1997

Background: Since 1987 we have run a Dermatologic Surgical Paediatric Outpatient Clinic (DSPOC) within the Children’s Hospital in Bordeaux. Objective: We analyse the consequences of an audit survey concerning the management of patients with congenital nevi (CN) seen at this clinic. Methods: We reviewed the cases of 192 children examined and photographed at the DSPOC during the period January 1990–December 1997. Patients were contacted for a reassessment of their status. The management options chosen at the DSPOC were reviewed as well as the satisfaction of the patients or parents of young children. Results: Of 192 children prerecruited, 56 girls and 52 boys could be included in the survey. They were mostly European whites and 67% were <6 months of age at the first DSPOC visit. 65/108 (61%) had been operated following the first DSPOC visit. The mean follow-up based on the 1997–1998 survey was 33 months (8 months to 10 years). The size of the nevus, independently of location, influenced decision for early surgery. Another important factor was the estimated disfigurement risk (15% of decisions) mostly related to CN of the face. There was a significant risk of pigmentary recurrence around the scar in children operated before the age of 2, but long-term follow-up indicated a spontaneously regressive course. Conclusions: Nevus recurrence in cases operated early suggests a time-dependent phenomenon in nevogenesis. Early counselling is important. Early surgery seems associated with a better scar quality. Explanations concerning risks and outcome are best given with the cooperation of a surgeon and a dermatologist.

Surgical management of congenital nevi

Surgical management of congenital nevi

Q-Switched Ruby Laser Treatment of Congenital Nevi

The Q-switched ruby laser has been used to treat a number of cutaneous lesions, including lentigines, 1 tattoos, and nevus of Ota. 2 The Q-switched ruby laser emits visible red light with a wave-length of 694 nm and pulse duration of 28 to 40 nanoseconds. This relatively long wavelength and short pulse duration allow for the absorption of laser energy into the dermis with minimal textural changes. Laser energy is selectively absorbed by both keratinocytes and melanocytes containing melanosomes. Although melanin in these melanosomes has an absorption spectrum that is highest in the UV range, diminishing toward the infrared range, there is minimal competitive absorption of ruby energy (694 nm) by oxyhemoglobin. 3 Management of congenital nevi has been the subject of much debate over the past decade. This stems from the unresolved controversy concerning their potential for malignant degeneration, specifically to malignant melanoma. We report on the use

Risk of Malignant Transformation of Congenital Melanocytic Nevi in Blacks

The risk of small congenital melanocytic nevi (CMN) developing into melanoma is not known, but is highly controversial. The frequency of small CMN is, paradoxically, slightly higher in some populations, such as blacks, who are at a lower risk of developing melanoma than whites. An estimate of the risk of malignant transformation of CMN in such a low-risk population could help in the management of congenital nevi in these patients and might also shed light on the inherent malignant risk of small CMN. We used a national population-based cancer registry, the Surveillance, Epidemiology, and End Results program (SEER), and the incidence of CMN in blacks taken from published newborn surveys to calculate a risk of malignant transformation. We calculated a maximum risk using a model based on a worst-case scenario, assuming that all melanomas on glabrous skin arise in CMN. We also calculated a modified risk based on the known historical association of nevi and melanomas in blacks, and estimates of the histologic association of the two. The cumulative maximum risk of malignant transformation in blacks to age 75 years was 1 in 164. It was strongly age dependent, with the majority occurring in persons over age 45. The estimated maximum risk before age 15 was less than 1 in 10,000 CMN, and in blacks age 15 to 35 less than 1 in 3700 CMN. The modified risk suggests that the worst-case scenario overestimates the risk by at least a factor of 12, making the actual risk in blacks up to age 75 approximately 1 in 2000.(ABSTRACT TRUNCATED AT 250 WORDS)