Congenital giant pigmented nevi: Clinical features and risk of malignancy

Abstract

Surg 1996;4(2):94-98. There is general agreement that congenital giant pigmented nevi (CGPN) are precursors to malignant melanoma; however, the magnitude of the risk of malignant transformation is the subject of wide controversy. The goal of this study was to present the authors' experience with CGPN and more specifically their experience with the risk of malignancy. To identify the general features of CGPN a detailed retrospective chart review was performed at The Hospital for Sick Children in Toronto (1979Toronto ( to 1994. There were 39 boys and 45 girls. The average size at presentation was 5.24% of the body surface area, and 36.9% of the nevus were located on the head and neck. An important finding was the high percentage of associated extra cutaneous disorders in patients with CGPN (23%) including a case of leptomeningeal melanocytosis. Tissue expansion was the most commonly used treatment modality. One case of malignant melanoma arising from CGPN was identified. To ensure that all cases of malignant melanoma were identified in this cohort, a questionnaire was sent to all plastic surgeons in Ontario (n=118), and data from the Ontario Cancer Registry were reviewed using the diagnostic codes for malignant melanoma and for pigmented nevus. One case of malignant melanoma was identified in all records. Thus CGPN poses a significant management challenge to the plastic surgeon and the risk of malignancy is low. Key Words: Congenital nevus, Giant hairy nevus, Malignant melanoma Naevi pigmentaires géants congénitaux: Caractéristiques cliniques et risque de cancer RÉSUMÉ :On s'entend en général sur le fait que les naevi pigmentaires géants congénitaux (NPGC) soient des précurseurs du mélanome malin; or, l'ampleur du risque d'une évolution maligne fait l'objet d'une importante controverse. Le but de cette étude était de présenter l'expérience des auteurs en matière de NPGC et plus précisément, leur expérience à mesurer le risque d'une évolution néoplasique. Pour identifier les caractéristiques générales des NPGC, un bilan rétrospectif sous forme de tableau détaillé a été dressé au Hospital for Sick Children de Toronto (1979 à 1994. Le groupe comprenait 39 garçons et 45 filles. La taille moyenne au moment de la première consultation était de 5,24 % de la surface corporelle, et 36,9 % des naevi se trouvaient dans la région de la tête et du cou. Une importante observation a été le fort pourcentage CAN

Management of challenging congenital melanocytic nevi: Outcomes study of serial excision

“…The risk of malignant degeneration as well as psychosocial morbidity from disfigurement merit resection of these lesions [1,2]. Melanocytic nevi can be classified as "small", "medium", "large", or "giant" based on their dimensions in centimeters or by TBSA; although, a consensus definition does not exist [7,[13][14][15].…”

“…Inclusion criteria were: (1) lesions that required at least 3 excisions to remove and (2) melanocytic congenital that could have been managed with skin grafting or tissue expansion. Patient age, gender, location of the lesion, size of the nevus [% total body surface area (TBSA)] [2,6,7], number of serial excisions, histopathology, and complications were recorded. Data are presented as mean with standard deviation or range.…”

Large or multiple congenital melanocytic nevi: Occurrence of cutaneous melanoma in 1008 persons

“…Multiple reports [2][3][4][5][6][7][8][9][10][11][12] regarding the risk of malignant degeneration of this neuroectodermal malformation have been published, but information regarding large numbers of affected persons has been nonexistent. In this article, the characteristics of 1008 such persons are described.…”

A Case of Giant Hairy Pigmented Nevus of Face

“…In addition, concerns about lack of parameters to predict as to which nevi are susceptible to malignant transformation, compounded with the fact that the diagnosis gets delayed and the course in case of a malignant change is invariably fatal are reasonable [5]. A recent review [8] has concluded that an early aggressive approach to these lesions is responsible for the low risk of malignant melanoma reported in various series. Surgical excision results in the debulking of tissue at risk for the development of malignant melanoma.…”