Abstract
Background
Congenital melanocytic nevi (CMN) has an incidence of 1–2% in newborns. These lesions can be categorized according to size, namely small, medium, large, and giant. Complete surgical excision is the main line of treatment with reconstruction by serial excision, tissue expansion, local flaps, Integra with skin graft, and skin grafting. Other modalities include curettage, dermabrasion, and laser. The aim of this article was to express the versatility of skin grafts for management of giant nevus.
Methods
All cases with lesions that cannot be closed primarily were included. Patients were 12 females and 4 males. Their ages ranged between 4 months and 22 years. All cases were excised and covered with skin graft.
Results
Full-thickness skin graft was used in combination with split-thickness sheet graft in four cases. All these cases were in the face. The average area of excised nevus was 225.5 cm2. No signs of malignancy were observed in any of the excised nevi. No recurrence was observed in this series.
Conclusions
Surgical and nonsurgical modalities are variable tools for management of giant congenital nevus. No doubt, skin graft is a good option for management of giant nevus.
Level of Evidence: IV, therapeutic study.
Similar content being viewed by others
References
Kroon S, Clemmensen OJ, Hastrup N (1987) Incidence of congenital melanocytic nevi in newborn babies in Denmark. J Am Acad Dermatol 17:422–426
Ruiz-Maldonado R (2004) Measuring congenital melanocytic nevi. Pediatr Dermatol 21:178–179
Recio A, Sánchez-Moya AI, Félix V, Campos Y (2017) Congenital melanocytic nevus syndrome: a case series. Actas Dermosifiliogr. doi:10.1016/j.ad.2016.07.025
Gowda VK, Basude A, Srinivas SM, Bhat M (2016) Giant melanocytic nevi with neurocutaneous melanosis masquerading as neurofibromas. J Pediatr Neurosci 11(3):258–260
Zaal LH, Mooi WJ, Klip H, van der Horst CM (2005) Risk of malignant transformation of congenital melanocytic nevi: a retrospective nationwide study from The Netherlands. Plast Reconstr Surg 116:1902–1909
Hassanein AH, Rogers GF, Greene AK (2015) Management of challenging congenital melanocytic nevi: outcomes study of serial excision. J Pediatr Surg 50(4):613–616
Liu Y, Huang J, Wen K, Liu N, Wang J (2012) Treatment of giant congenital melanocytic nevus of the left upper extremity with staged expanded flap. J Plast Reconstr Aesthet Surg 65(2):258–263
Güerrissi JO (2009) Total forehead flap: hemicraniofacial giant congenital melanocytic nevus. J Craniofac Surg 20(2):522–524
Schiestl C, Stiefel D, Meuli M (2010) Giant naevus, giant excision, eleg(i)ant closure? Reconstructive surgery with Integra Artificial Skin to treat giant congenital melanocytic naevi in children. J Plast Reconstr Aesthet Surg 63(4):610–615
Criscito MC, Correa LM, Koshenkov VP, Firoz BF (2016) Recurrent nevi in a skin graft following excision of Giant congenital melanocytic nevus. Dermatol Surg 42(9):1113–1116
Casanova D, Bardot J, Andrac-Meyer L, Magalon G (1998) Early curettage of giant congenital naevi in children. Br J Dermatol 138:341–345
Johnson HA (1977) Permanent removal of pigmentation from giant naevi by dermabrasion in early life. Br J Plast Surg 30:321–323
Reynolds N, Kenealy J, Mercer N (2003) Carbon dioxide laser dermabrasion for giant congenital melanocytic nevi. Plast Reconstr Surg 111(7):2209–2214
Cramer SF (2001) Speckled lentiginous nevus (Nevus spilus): the “roots of the melanocytic garden”. Arch Dermatol 137:1654–1655
Heffek DF, Thaller S (2005) Congenital melanosis: an update. J Craniofac Surg 16:940
Lorentzen M, Pers M, Bretteville-Jensen G (1977) The incidence of malignant transformation in giant pigmented nevi. Scand J Plast Reconstr Surg 11:163
Takayama H, Nagashima Y, Hara M et al (2001) Immunohistochemical detection of the c-met proto-oncogene product in the congenital melanocytic nevus of an infant with neurocutaneous melanosis. J Am Acad Dermatol 44:538
Bittencourt FV, Marghoob AA, Kopf AW et al (2000) Large congenital melanocytic nevi and the risk for development of malignant melanoma and neurocutaneous melanocytosis. Pediatrics 106:736
Pilney FT, Broadbent TR, Woolf M (1967) Giant pigmented nevus of the face. Plast Reconstr Surg 40:469
Reed WB, Becker SW Sr, Becker SW Jr, Nickel WR (1965) Giant pigmented nevi, melanoma and leptomeningeal melanocytosis. Arch Dermatol 91:100–119
Rhodes AR, Wood WC, Sober AJ, Mibry MC Jr (1981) Nonepidermal origin of malignant melanoma associated with giant congenital nevocellular nevus. Plast Reconstr Surg 67:782–790
Michel JL (2003) Laser therapy of giant congenital melanocytic nevi. Eur J Dermatol 13(1):57–64
Chan YC, Giam YC (2006) A retrospective cohort study of southeast Asian patients with large congenital melanocytic nevi and the risk of melanoma development. J Am Acad Dermatol 54(5):778–782
Zitelli JA, Grant MG, Abell E, Boyd JB (1984) Histologic patterns of congenital naevocytic nevi, implicationsfor treatment. J Am Acad Dermatol 11:402–404
Hori Y, Nakayama J, Okamoto M (1989) Giant congenital nevus and malignant melanoma. J Invest Dermatol 92:310S–4S.09
Moehrle M, Lischner S, Dunsche A, Breuninger H, Hauschild A (2002) Cerebriform giant melanocytic nevus of the scalp: report of two cases with different surgical approaches. Dermatol Surg 28(1):75–79
Ding JP, Chen B, Fang L, Wang LZ (2016) Total reconstruction of giant congenital circumferential nevi of the upper limb using a large pedicle expanded flank flap: a brief report. Ann R Coll Surg Engl 98(8):e150–e151
Shachar Y, Billig A, Chapchay K, Elia J, Adler N, Margulis A (2016) Expanded bi-pedicled “sleeve” flap for reconstruction of the upper extremity after large circumferential nevus excision in children. J Plast Reconstr Aesthet Surg 69(12):1676–1682
Iwahira Y, Maruyama Y (1993) Expanded unilateral forehead flap (sail flap) for coverage of opposite forehead defect. Plast Reconstr Surg 92:1052
Tønseth KA, Filip C, Hermann R, Vindenes H, Høgevold HE (2015) Extraordinary large giant congenital melanocytic nevus treated with Integra dermal regeneration template. Plast Reconstr Surg Glob Open 3(7):e469
Rasmussen BS, Henriksen TF, Kølle SF, Schmidt G (2015) Giant congenital melanocytic nevus: report from 30 years of experience in a single department. Ann Plast Surg 74(2):223–229
Liem PH, Morimoto N, Ito R, Kawai K, Suzuki S (2013) Autologous skin reconstruction by combining epidermis and acellular dermal matrix tissue derived from the skin of giant congenital melanocytic nevi. J Artif Organs 16(3):332–342
Sood R, Balledux J, Koumanis DJ, Mir HS, Chaudhari S, Roggy D, Zieger M, Cohen A, Coleman JJ (2009) Coverage of large pediatric wounds with cultured epithelial autografts in congenital nevi and burns: results and technique. J Burn Care Res 30(4):576–586
Kryger ZB, Bauer BS (2008) Surgical management of large and giant congenital pigmented nevi of the lower extremity. Plast Reconstr Surg 121(5):1674–1684
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
For this kind of study did not require formal consent from a local ethics committee.
Funding
No source of funding for the article.
Conflict of interest
Ahmed Hassan El-Sabbagh declares he has no conflicts of interest.
Informed consent
Informed consent was obtained from all patients or their parents.
Patient consent
Patients or their legal guardians provided written consent for the use of their images.
Rights and permissions
About this article
Cite this article
El-Sabbagh, A.H. Is there still a place for skin graft in giant congenital melanocytic nevus?. Eur J Plast Surg 41, 177–182 (2018). https://doi.org/10.1007/s00238-017-1344-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-017-1344-5