Giant congenital pigmented nevi of the face: Operative management and risk of malignancy

Abstract

A l though gi ant con geni tal nevi of the face are rare lesions, they pres ent a ma jor chal lenge to the plas tic surgeon. The di ag no sis of 'co ngen ital ne vus' is made from the pres ence at birth of cu ta ne ous nevo cytes or mela no cytes which form a pig mented le sion. Pathol ogi cally, they are nearly al ways re ported to be in trad er mal or com pound nevi, of ten as so ci ated with mul ti ple small nevi in other ar eas of the body. Café-au-lait spots, mes en chy mal tu mours (fi bro mas, li po mas), Von Reck ling housen's dis ease, vas cu lar nevi and other skin anoma lies are of ten found in con junc tion with facial nevi (1-5) .The gi ant con geni tal mela no cytic ne vus is a rare neuroec to der mal le sion oc cur ring in ap proxi mately one of every 20,000 new borns (4,6). The oc cur rence of gi ant con geni tal nevi of the face is even rarer, and can in volve a va ri ety of sizes and fa cial dis tri bu tion. A great deal of con tro versy exists about the defi ni tion of 'g iant'; pro posed defi ni tions have in cluded: in volve ment of a ma jor por tion of the face, an area larger than the pa tients palm, in volve ment be ing larger than 900 cm 2 , with the larg est di ame ter be ing at least 20 cm (8); a per cent age of body sur face area (9); an area im pos si ble to excise with out a sig nifi cant de form ity (10); or any le sion that pre cludes com plete ex ci sion and pri mary clo sure of the defect in a sin gle op era tion (11,12). Al though it is well docu mented that gi ant pig mented nevi un dergo ma lig nant trans for ma tion, the in ci dence var ies in the lit era ture and has not been de ter mined pre cisely. The rela tion be tween gi ant con geni tal nevi of the face and lep tomen in geal mela noma is of par ticu lar clini cal im por tance (13-16). We re viewed gi ant con geni tal pig mented nevi of the face to as sess the dis tri bu tion of the le sions and evalu ate our ex pe ri ence in their sur gi cal man age ment. An at tempt is made to in ves ti gate the risk of ma lig nancy aris ing from these lesions. RM Zuker, TG Icono mou, B Mi che low. Gi ant con geni tal pig mented nevi of the face: Op era tive man age ment and risk of ma lig nancy. Can J Plast Surg 1994;3(1):39-44. Gi ant con geni tal pig mented nevi of the face are rare but of ma jor con se quence. Com plete early ex ci sion of these le sions is rec om mended not only be cause of the cos metic de form ity they im pose but also be cause of their life threat en ing po ten tial for ma lig nant trans for ma tion. At the Hos pi tal for Sick Chil dren in To ronto 19 pa tients with gi ant con geni tal nevi of the face were re viewed. The ana tomi cal lo ca tion of the le sions, their mor pho logi cal and his to logi cal char ac ter istics, and the authors' ex pe ri ence with sur gi cal man age ment of these le sions were evalu ated. The risk of ma lig nancy aris ing from these le sions was also evalu ated. In this study, one pa tient died of lep to men in geal mela no cy to sis as so ci ated with her gi ant con genital ne vu...

Congenital giant pigmented nevi: Clinical features and risk of malignancy

“…Serial excision, tissue expansion and skin grafting (13,22,23,33,34) remain the most frequently used methods to treat CGPN. However, in any treatment program, there must be awareness of the nonepidermal origin of malignant melanoma in CGPN as reported by Rhodes et al (35).…”

Serial Tissue Expansion and Skin Grafts in the Management of a Giant Congenital Nevus of the Face: Review of Literature and Case Report

“…Trần Thiết Sơn 1,2,3 , PhD, MD; Phan Tuấn Nghĩa 1,2 , MD; Phạm Thị Việt Dung 1,2 , PhD; Tạ Thị Hồng Thuý 1,2 ,MD; Hoàng Tuấn Anh 1 , PhD, MD; Lê Anh Huy 2 , MD…”

“…Hemifacial lesions are the most difficult to treat among the head-related GCN. Early surgical management of these lesions is recommended due to their malignant potential [1,2]. The surgical literature documents the use of tissue expansion to repair significant defects resulting from GCN resection on the face [3,4].…”

“…Early surgical management of these lesions is recommended due to their malignant potential. 1 2 The surgical literature documents the use of tissue expansion to repair significant defects resulting from GCN resection on the face. 3 4 Occasionally, serial tissue expansion is necessary to recruit enough skin for complete facial reconstruction.…”