[Therapy of congenital melanocytic nevi. Excision, dermabrasion, laser]

Treatments of palpebral congenital melanocytic nevus: a systematic review

PURPOSE

Palpebral congenital melanocytic nevi (PCMN) is a rare congenital skin lesion affecting the eyelids that can lead to cosmetic and psychological concerns and potential health risks such as malignancy. Several authors have analyzed therapeutical strategies to treat PCMN. However, there was no consensus in the literature. This systematic review aimed to evaluate the effectiveness, safety, and success of treatments of PCMN.

METHODS

We conducted a systematic review following PRISMA guidelines from October 2022 to April 2023. We included all types of study designs that described or compared PCMN treatments and interventions, as well as histology, recurrence, adverse events, patient satisfaction, and malignant transformation. The search strategy was based on specific search words through the following databases: PubMed, Embase, Latin American and Caribbean Health Sciences Literature (Lilacs), Web of Science, and Scopus. Ongoing studies and gray literature studies were included.

RESULTS

We analyzed 25 case reports with 148 participants. The effectiveness, success, and satisfaction with various treatments for PCMN depend on the specific treatment method and the individual patient's case.

CONCLUSIONS

Most of the studies showed that surgical procedures (exeresis) are able to treat PCMN in the eyelid. The variability in outcomes emphasizes the importance of further research to better understand the most effective and safe approaches for treating congenital melanocytic nevi.

Treating Giant Congenital Nevus With Integra Dermal Regeneration Template in a 9-Year-Old Girl

Integra dermal regeneration template has been well established in treating deep extensive burns, but there are very few cases reported of treating large full-thickness skin defects such as giant nevi. Apart from psychological and cosmetic burdens, the giant congenital nevus carries increased risk of malignant alteration. We present the case of a 9-year-old girl with a giant congenital nevus on her left lower leg. A total excision was done and she was successfully treated with Integra (LifeSciences Corp, Plainsboro, NJ). Three weeks later, a thin split-skin graft was applied over the neodermal skin layer. The takeoff was 91%. Protected with the silver wound dressing, the rest of the wound healed. A donor site morbidity was minimal, and the final result was excellent both in aesthetic and functional aspects.

Divided nevus of the eyelid: successful treatment with CO2 laser

BACKGROUND

Divided nevus of eyelid is a rare form of congenital nevus. It can cause cosmetic and psychological problems. The aim of the treatment is to reliably remove the lesion with minimal functional impairment, to improve the cosmetics, and to prevent canceration.

METHODS

The paired nevi were treated with CO2 laser by local anesthesia. Ablation was stopped after all the visible pigment tissues were removed and normal tissues became visible, shaping the basilar part to get good cosmetic results, avoiding thermally damaging the lower dermis as far as possible to minimize the side effect.

RESULTS

It showed good cosmetic results 5 months after the last operation without any functional impairment except for a little repigment on the upper lid, superficial scar on the lower lid, and hypopigmentation on both of the wounds.

CONCLUSIONS

With the advantages of simplicity, precision, and effectiveness, CO2 laser can be recommended to treat small divided nevus with special type and clinical characteristics. It can help to simplify the treatment, get good cosmetic results, and avoid skin graft.

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

BACKGROUND

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.

OBJECTIVE

THE PURPOSE OF THIS STUDY IS TO EVALUATE THE OUTCOME OF A COMBINATION OF SURGICAL EXCISION WITH ER: YAG laser ablation for treating CMNs.

METHODS

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.

RESULTS

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.

CONCLUSION

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.