The Shifting Paradigm in the Management of Giant Congenital Melanocytic Nevi

Abstract

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.

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].…”

Malignant Transformation of a Multi-Operated Divided Nevus of the Eyelids

“…Due to the low risk of malignant transformation, these partial excisions are acceptable [14]. Lifelong clinical follow-up is recommended.…”

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

“…The term congenital melanocytic nevi (CMN) refers to clonal proliferations of benign melanocytes that are present at birth but may not become apparent until the first few months of life . The incidence rate ranges between 1%‐2% for small and 1:20 000 for so‐called giant lesions (CMN larger than 40 cm in diameter based on their projected adult size [PAS]) . The two life‐threatening complications associated with CMN are neurocutaneous melanocytosis (NCM) and melanoma (MM) …”