Medium-sized Congenital Melanocytic Nevi Research Articles

Reconstruction of a medium-sized congenital melanocytic nevus defect using a thin thoracodorsal artery perforator free flap: a case report

Congenital melanocytic nevus (CMN) is a benign condition that either is present at birth or develops in the first weeks of life. Surgical removal is typically performed to improve cosmetic appearance and reduce the risk of malignant transformation. In this report, we present the case of a 26-year-old woman with a medium-sized CMN on her left breast. The nevus measured 14×8 cm, and the patient desired a single-stage excision. However, this approach would result in a large skin defect that would be challenging to reconstruct using a local flap or skin graft. Moreover, it could potentially compromise the maintenance of natural sagging and the contour of the breast. Consequently, we opted to place a thin thoracodorsal artery perforator free flap following the removal of the CMN. The patient was satisfied with the overall surgical results. By utilizing this free flap for reconstruction, we successfully preserved the natural shape and contour of the breast without complications such as postoperative hypertrophic scarring or contracture at the recipient site.

Non-multiple medium-sized congenital melanocytic nevi: to excise or to follow up?

Congenital melanocytic nevi (CMN) are benign lesions composed of clonal proliferations of melanocytes. Although medium-sized CMN are common and generally remain benign throughout a person's lifetime, they may be precursors of melanoma. There is a limited number of studies focused on the risk of melanoma in solitary, medium-sized, congenital melanocytic nevus; therefore, the incidence of malignant transformation and guidelines for treatment are not well established. Prompted by the limited data, we conducted this study to gather more information about medium-sized CMN, to optimize clinical care. We share our analysis of surgically removed medium-sized CMN. A total of 10 patients with non-multiple, medium-sized, congenital melanocytic nevus were included in this study. Lesions were removed using surgical procedures. In most of the cases the reason for excision of the medium-sized CMN was evolution of the lesion or aesthetic considerations reported by the patients. In 2 cases, due to the large size of the lesions, serial excisions were performed, while other CMN were removed surgically using simple excision technique. Eight of 10 medium-sized CMN were histologically described as benign, and 2 cases of malignant transformations were reported. According to our clinical experience and knowledge, we recommend managing patients on an individual basis, taking into consideration multiple clinical attributes. In our opinion, long-lasting observation is the management of choice, and if there is need of surgery, we recommend total simple or staged excision depending on nevus size.

Dufourmentel flap for surgical treatment of medium-sized congenital melanocytic nevi on the extremities.

Congenital melanocytic nevi (CMN) are quite common benign proliferations of cutaneous melanocytes. They are present at birth or arise during the first few weeks of life being upper and lower extremities one of the most common locations. To date, consistent guidelines for clinical management of CMN do not yet exist and the main reasons for removing them are medical and cosmetic. Regardless of the cause of having a CMN removed, when it comes to surgical excision of the lesion in daily practice, the single most important decision to make is how to properly close the post-excisional defect. The local Dufourmentel skin flap seems to be a reliable solution for surgical treatment of medium-sized CMN on the limbs. It takes advantage of skin laxity adjаcent to thе defect to allоw the transpositiоn of tissuе with similаr charactеristics tо the tissuе еxcisеd, which is the key for achieving good aesthetic and functional outcomes. In this brief clinical study, the author identified a group of adult patients, who had medium-sized CMN located on their extremities. The surgical technique is explained and useful tips are given. No complications and high patient satisfaction rate were registered in the series. Dufourmentel flap is a useful tool in the armamentarium of dermatologic surgery when dealing with medium-sized CMN on the extremities. Furthermore, due to its versatility this flap could also be applied for other clinical indications both benign and malignant.

An Unusual Pigmented Plaque in a Newborn.

An Unusual Pigmented Plaque in a Newborn.

Medium-Sized Congenital Melanocytic Nevus with Halo Phenomenon: A Report of Two Cases

Congenital melanocytic nevi with halo phenomenon in children is a rare clinical finding. We report two cases of children who developed depigmentation within medium-size congenital melanocytic nevi. Clinicians should be suspicious when confronted with this phenomenon due to the risk of development into malignant melanoma. Herein, we review these rare cases of medium-sized halo congenital melanocytic nevi with and without associated vitiligo, with emphasis that depigmentation does not necessarily indicate malignant growth.

Letter in response to the article: “A retrospective case series of ten patients with malignant melanomas arising from small- and medium-sized congenital melanocytic nevi in South Koreans”

Letter in response to the article: “A retrospective case series of ten patients with malignant melanomas arising from small- and medium-sized congenital melanocytic nevi in South Koreans”

18F-FDG PET/CT Imaging in an Unusual Case of Cutaneous Melanoma Arising From Congenital Melanocytic Nevus in a Two-year-old Girl

Childhood malignant melanoma (MM) is extremely uncommon. We report an unusual case of cutaneous melanoma that developed from a medium-sized congenital melanocytic nevus (CMN) in a two-year-old girl. The patient had a history of CMN on the right hip, and she presented with a new ulcerative area with irregular borders and bleeding on CMN. Histopathological examination of the nevus revealed a MM. 18Florfluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography was performed for metastatic evaluation. The scan demonstrated metastatic increased 18F-FDG uptake in the right external iliac and inguinal lymph nodes.

Cutaneous Melanoma Arising in Congenital Melanocytic Nevus: A Retrospective Observational Study

Background: Congenital melanocytic nevi (CMN) are benign proliferations of melanocytes usually present at birth. The magnitude of the melanoma risk for CMN is controversial, generating an ongoing debate on the best approach to manage these lesions. Objective: To perform a retrospective, observational study with the aim to evaluate the prevalence of CMN-associated melanomas in tertiary referral centers, as well as the eventual correlation between clinical, dermoscopic, and histological features of CMN-associated melanomas. Methods: A single-center retrospective observational study was performed on all clinical and dermoscopic images of histologically confirmed melanomas arising on CMN over a 14-year period (January 2005 to March 2019). Results:Our database included 2,159 melanomas in the considered period. Of those, 27 (1.3%) were CMN-associated melanomas. The mean age of patients with CMN-associated melanoma was 33 years (range, 11–70 years). The mean diameter of CMN-associated melanoma was 18 mm (range, 6 mm to 20 cm), and 56% were located on the back. Twenty-one (77.8%) of CMN-associated melanomas arose on small CMN (<1.5 cm), 5 (18.5%) on medium-sized CMN (1.5–19.9 cm), and 1 (3.7%) on a large/giant type (≥20 cm). The majority of CMN-associated melanomas (63%) exhibited a globular dermoscopic pattern in their benign part, while a blue-white veil and irregular blotches were the most frequent dermoscopic features in the malignant part. About three quarters of melanomas occupied 10–50% of the nevus surface. Breslow thickness was higher in melanomas involving less than 10% of nevus surface (mean thickness, 1 mm) than in those affecting 10–50 and >50% of the nevus surface (0.8 and 0.7 mm, respectively). Conclusions: In our series, small CMN was the most frequent type of CMN-associated melanoma. Although the risk of melanoma is increasing by the increasing size of CMN, our finding is definitely related to the much higher prevalence of small CMN in the general population as compared to the prevalence of intermediate-sized and large CMN. Limitations: Small sample size, single-center experience, retrospective design.

Prepubertal Melanoma Arising within a Medium‐Sized Congenital Melanocytic Nevus

We report the case of an 8-year-old child who developed a 9.4-mm-deep melanoma within a medium-sized congenital melanocytic nevus on the scalp. Genetic analysis revealed an activating NRAS Q61R mutation within the melanoma, which is more commonly associated with large or giant congenital melanocytic nevi. This case demonstrates that even a "low-risk" congenital melanocytic nevus at a "low-risk" age must be monitored regularly for the development of malignancy.

Neurocutaneous Melanosis: An Illustrative Patient

We present a newborn with an unremarkable birth history who presented with a giant congenital melanocytic nevus with a “bathing trunk” distribution, accompanied by multiple satellite nevi (Fig 1). Cranial magnetic resonance imaging revealed multiple hyperintense lesions of the brain parenchyma and leptomeninges (Fig 2), confirming the diagnosis of neurocutaneous melanosis. At 13 months, he developed a partial seizure with secondary generalization. He had been asymptomatic until then. Antiepileptic treatment with valproic acid was started. Subsequently he has had occasional seizures that have required antiepileptic readjustment but has otherwise been well. Currently he is 3 years of age and has been seizure-free for 18 months with only mild developmental delay and no apparent progression of his neurocutaneous melanosis. Discussion Congenital melanocytic nevi are proliferations of benign melanocytes that arise during embryogenesis. Neurocutaneous melanosis is a complication of congenital melanocytic nevi and consists of proliferation of melanocytes in the central nervous system and leptomeninges as well as in the skin. It occurs in 2.5-45% of patients with congenital melanocytic nevi, 1 and the risk factors include large congenital melanocytic nevus, multiple satellite nevi, and more than two medium-sized congenital melanocytic nevi. 2-4 Neurocutaneous melanosis can be either symptomatic (3-10% of infants and children with congenital melanocytic nevi 2 ) or asymptomatic. Symptoms usually present in the first 2 years of life as developmental delay and/or seizures, 2 and the prognosis of symptomatic individuals is poor. Neurocutaneous melanosis is best

Treatment of a Congenital Melanocytic Nevus on the Forehead with Immediate Tissue Expansion Technique: A Three‐Year Follow‐Up

The aim of this case report was to determine the method and basic principles of immediate tissue expansion using a Foley catheter in the forehead region for treating a medium-sized congenital melanocytic nevus. A 4-year-old child presented with a supraorbitally located forehead congenital melanocytic nevus, close to the midline. Total excision and reconstruction with intraoperatively expanded forehead skin below the hairline was performed. Intraoperative tissue expansion using a Foley catheter allowed us to obtain expanded and enhanced local tissue, which had tissue characteristics similar to those of the forehead skin, and thus closure of a medium-sized defect without distorting important anatomic structures such as the brow and frontal hairline was possible. Of the two methods of tissue expansion, immediate expansion using a Foley catheter is a good alternative in single-stage reconstruction of head and neck defects because it has the advantage of omnidirectional expansion.

An unusual case of multiple angiokeratomas arising on a medium-sized congenital melanocytic nevus

An unusual case of multiple angiokeratomas arising on a medium-sized congenital melanocytic nevus

Angiotropic Neonatal Congenital Melanocytic Nevus: How Extravascular Migration of Melanocytes may Explain the Development of Congenital Nevi

In the following report we describe a medium-sized congenital melanocytic nevus (CMN) on the upper back of a female patient biopsied at 9 days of age. This case is a unique variant of CMN occurring in the neonatal period that mimics malignant melanoma. This is not only because of histologic features such as a large round or ovoid cellular phenotype of melanocytes mimicking melanoma cells but also because of conspicuous angiotropism, a finding not previously reported in such CMN. Immunostaining for blood and lymphatic vessels demonstrated angiotropism of melanocytes about blood vessels but not lymphatics. We have already emphasized the significance of angiotropism as a marker of extravascular migratory metastasis (EVMM) of melanoma. EVMM, a process by which tumor cells migrate along vessels and other tracks, has striking parallels with the migration of embryonic stem cells from the neural crest. Thus we propose, because angiotropism is a common finding in CMN and metastatic melanoma, that (1) such pathways of cellular migration may result in the genesis of CMN and other melanocytic neoplasms; and (2) the dysregulation of such embryonic pathways may result in the retrograde migratory phenomena of melanoma as already described. In summary, extravascular cellular migration of melanocytes seems to be fundamental for melanoma (perhaps other cancer) metastasis but also hypothetically may be important for the development of other melanocytic lesions such as CMN and requires further investigation.

Clinical and dermoscopic features of congenital melanocytic nevi

Congenital melanocytic nevi (CMN) are nevomelanocytic nevi which are present at birth. In this study, we set out to determine the clinical and dermoscopic properties of CMN. A total of 239 lesions were diagnosed as CMN. Dermoscopic properties were noted. Age, sex, nevus location and nevus size of the patients were also collected from the patient records. A total of 239 lesions were diagnosed as CMN in 239 patients (age ranged from 1 month to 63 years (20.79 ± 13.76 yr); 114 [47.7%] males and 125 [52.3%] females). Most of the lesions were medium-sized CMN, followed by small and large ones. The most common localization was upper extremities (23.8%), followed by head and neck, back, and lower extremities respectively. Dark brown was the most common colour seen in dermoscopy (115 patients, 48.1%), followed by light brown (69 patients, 28.9%) and black (55 patients, 23%) respectively. The most common dermoscopic findings of CMN was hair follicles followed by dots (70%) and perifollicular hypopigmentation (51%). Our study describes the normal clinical and dermoscopic features of CMN. It should be kept in mind that, CMNs are quite common lesions, and melanomas can arise from them. Knowing and being familiar with the normal properties of these common nevi will help us determine whether a nevus is suspicious or not.

Congenital melanocytic nevi—when to worry and how to treat: Facts and controversies

Congenital melanocytic nevi (CMN) are evident in 1% to 6% of neonates. In some studies, nevi with clinical, dermatoscopic, and histologic features identical to CMN have had a prevalence of more than 15% in older children and adults, possibly reflecting the “tardive” appearance of nevi programmed from birth. There is ongoing debate about the magnitude of the risk of melanoma and other complications associated with CMN of various sizes and the best approach to management of these lesions. We review the natural history of CMN, including proliferative nodules and erosions during infancy, neurotization, and spontaneous regression, and features of variants such as speckled lentiginous and congenital blue nevi. The risk of melanoma arising within small-sized (<1.5 cm) and medium-sized CMN is low (likely <1% over a lifetime) and virtually nonexistent before puberty. Recent data suggest that melanoma (cutaneous or extracutaneous) develops in approximately 5% of patients with a large (>20 cm) CMN, with about half of this risk in the first few years of life. Melanoma and neurocutaneous melanocytosis (NCM) are most likely in patients with CMN that have a final size of >40 cm in diameter, numerous satellite nevi, and a truncal location. One-third of individuals with NCM have multiple medium-sized (but no large) CMN. In patients at risk for NCM, a screening gadolinium-enhanced magnetic resonance imaging, preferably before age 6 months, and longitudinal neurologic assessment are recommended. Management of CMN depends on such factors as the ease of monitoring (more difficult for large, dark, thick nevi) and cosmetic and psychologic benefits of excision or other procedures. CMN require lifelong follow-up. Periodic total body skin examinations are necessary for all patients with large CMN, even when complete resection (often impossible) has been attempted.

A Case of Malignant Melanoma Arising in a Medium-Sized Congenital Melanocytic Nevus

A Case of Malignant Melanoma Arising in a Medium-Sized Congenital Melanocytic Nevus

A Combination of Dual-mode 2,940 nm Er:YAG Laser Ablation with Surgical Excision for Treating Medium-sized Congenital Melanocytic Nevus

There are various treatment options for congenital melanocytic nevus (CMN), including surgical excision, dermabrasions, curettage, laser treatment, chemical peels and cryosurgery. The proper choice of treatment depends on the size, location, thickness and clinical appearance of the nevi, the risk for developing melanoma, the psychological effect and the cosmetic component. THE PURPOSE OF THIS STUDY IS TO EVALUATE THE OUTCOME OF A COMBINATION OF SURGICAL EXCISION WITH ER: YAG laser ablation for treating CMNs. A total of 13 patients were included in this study. The nevus was excised as much as possible and only dermal suturing was performed, without epidermal suturing, for the primary closure. We then ablated the whole lesion, including the suture lines, by using a dual-mode 2,940 nm Er:YAG laser with three to five passes. All the lesions were followed up for 6 months and they were evaluated with respect to the healing status, infection, erythema, scarring, textural change and pigmentary change. Subject satisfaction was scored at the 16(th) week by the patients. Eleven (83%) of the 13 patients were clinically rated as having a good to excellent result by the physicians' Global Assessment Scale (GAS) scores for the lesions' reduction of size, the degree of scarring and the pigmentary change with only a one stage procedure. 10 (77%) of the total 13 patients reported a good to excellent result at four months after treatment. A combination of surgical excision with Er:YAG laser ablation as a one stage procedure is a safe, effective modality and it should be considered as one of the options for treating medium-sized CMNs.

Congenital Melanocytic Nevus: An Epidemiologic Study in Italy

Background: The prevalence of congenital melanocytic nevi (CMN) among newborns ranges between 0.2 and 6% in the worldwide literature. In the only available study from Italy the rate was 1% at birth and 1.4% at 2 years of age. Some surveys performed among samples of children and adolescents in other countries showed a prevalence which ranged from 1.4 to 4.4%. Additional data on the frequency in adults are not available. Objective: The aim of this study was to estimate the prevalence of CMN in a large sample of a young male Italian population, which is deemed to be representative of the general population of the same age and sex. Methods: The potential conscripts resident in the coastal regions of southern Italy, enlisted for the compulsory service in the Italian Navy, were called at the age of 18 to the Draft’s Council Medical Unit of the Italian Navy in Taranto to evaluate their psychophysical fitness to recruitment. All the subjects examined from September 2002 to March 2004 showing skin lesions evocative of CMN were referred by general practitioners of the Draft’s Council Medical Unit to the Department of Dermatology of the Italian Navy Hospital for confirming the diagnosis, which was based on the clinical features and the personal history. The confirmed cases were recorded in a predefined patient card, containing the main anamnestic and clinical data. Since the screening of small CMN in such a large sample of subjects was believed to be difficult, only CMN with a diameter ≧1.5 cm were recorded. Results: In 23,354 examined persons 157 CMN were diagnosed, with a prevalence of 0.67% (Bayesian 95% confidence interval 0.57–0.79); 126 (80.3%) CMN were medium-sized (≧1.5 and ≤19.9 cm in diameter), and 31 (19.7%) were large (≧20 cm in diameter). Three CMN (1.9%) were located on the face, 23 (14.6%) on the chest, 24 (15.2%) on the abdomen, 36 (22.9%) on the back, 48 (30.5%) on the lumbar area, 15 (9.5%) on the upper limb, 19 (12.1%) on the lower limb and 15 (9.5%) on the shoulder. No CMN was located on the head. In 19 cases (12.1%) ≧2 adjacent anatomical sites (shoulder/chest, shoulder/arm, etc.) were involved. In 73 moles (46.4%) terminal hairs were present. Eight CMN (5.1%) showed a zosteriform (i.e. segmental) feature. None of the examined subjects reported a personal history of malignant melanoma (MM), and no person with a history of MM was observed among all the enlisted men referred to the Department of Dermatology during the time of the study. Conclusion: The prevalence of CMN in the Italian young male general population is roughly in agreement with the rates detected in general populations from other European studies. The observations of this study also suggest that the risk of appearance of MM, at least in childhood and adolescence, is limited for medium-sized CMN.

中型先天性色素性母斑上に生じた有茎性悪性黒色腫の１例

We report a case of pedunculated malignant melanoma arising in a medium-sized congenital melanocytic nevus. A 31-year old woman had a rapidly growing pedunculated tumor at the edge of a hairy black macule on her left thigh. The macule was 50×15mm in size at the initial presentation. Pelvic CT scan showed multiple regional node metastases. Wide local excision, therapeutic groin dissection, neo-adjuvant and adjuvant DAV-IFNβ therapy (DTIC, ACNU, VCR, IFNβ) were performed. Histological examination showed congenital melanocytic nevus coexisting with malignant melanoma of pT4aN1M0 stage III, thickness 9mm, level IV. After two courses of adjuvant therapy, multiple liver, brain, and lung metastases were recognized. She died of the disease 3 months after the operation. The present case indicated that even a medium-sized congential melanocytic nevus had a risk for malignant melanoma. [Skin Cancer (Japan) 2000; 15: 49-52]

中型先天性色素細胞母斑に生じた悪性黒色腫の１例

A 63-year-old Japanese woman was referred to us with a 1-month history of a nodule arising within a lesion of medium-sized congenital melanocytic nevus of the left popliteal region. Physical examination showed a black plaque, 13.6×7.7cm, on the site, and at the periphery of which, a reddish black nodule, 1.8×1.4×0.5cm, was detected.Histopathological examination of the nodule revealed nests of atypical melanocytes in the upper dermis. The overlying epidermis was eroded and no proliferation of atypical melanocytes was found in the epidermis. The plaque lesion histologically showed diffuse proliferation of small nevus cells in the reticular dermis. The border between the atypical melanocytes and the nevus cells was somewhat indistinct. The atypical cells were epithelioid or spindle shaped, and mitotic figures were frequently detected. The atypical cells were stained with an antibody to S-100 protein and some of them were also stained with a HMB-45.This case is malignant melanoma arising from a medium-sized congenital melanocytic nevus. The stage was pT4a N2a M1a (Stage IV).She underwent wide local resection along with subtotal integumentectomy and radical lymph node dissection of her left inguinal area. DAV-feron (DTIC, ACNU, VCR, IFN-β) therapy was administered postoperatively. However, soon later, metastases to lung, bones, and brain developed. She died from the disease on July 9, 1999.