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Gout HA, Fledderus AC, Lokhorst MM, Pasmans SGMA, Breugem CC, Lapid O, van der Horst CMAM. Safety and effectiveness of surgical excision of medium, large, and giant congenital melanocytic nevi: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 77:430-455. [PMID: 36652871 DOI: 10.1016/j.bjps.2022.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/28/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Treatment indications of congenital melanocytic naevi (CMN) have shifted from the prevention of malignant transformation more towards the improvement of appearance and psychosocial health. Surgical excision is often preferred, but its safety and effectiveness remain unclear. OBJECTIVE To assess the outcomes of surgical excision of medium-to-giant CMN. PRIMARY OUTCOME safety (complications). SECONDARY OUTCOME effectiveness (satisfaction and CMN core outcomes). METHODS PubMed, EMBASE, and CENTRAL were searched for studies on the excision of medium-to-giant CMN and/or CMN requiring reconstruction or serial excision. Meta-analyses of safety per patient were conducted, and pooled outcomes of safety and effectiveness were presented in summary-of-findings tables. RESULTS A total of 1444 studies were found, of which 22 were included, evaluating 643 eligible patients. Study quality varied, and reporting of baseline characteristics and outcomes was heterogeneous. Pooled proportions were overall 9.8% for major wound-related complications, 1.2% for minor wound-related complications, 1.2% for scar-related complications, and 4.3% for anatomical deformities. For large/giant CMN, complication rates were, respectively, 23.1%, 2.9%, 12.9%, and 2.4%; and for CMN with eyelid involvement, 0.5%, 3.3%, 0.4%, and 54.2%. Patients rated their satisfaction with the cosmetic outcome as 24.4% excellent, 71.0% good, and 4.6% poor/moderate. Physicians rated this as 18.3% excellent, 70.1% good, and 11.7% poor/moderate. Thirty-five other outcomes of effectiveness were summarized. However, many were rarely reported. CONCLUSIONS Surgical excision of CMN appears to be safe and effective in many cases, depending on CMN size and location. Major wound-related complications and scar-related complications occurred more frequently with large/giant CMN, whereas anatomical deformities occurred with the majority of CMN with eyelid involvement.
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Affiliation(s)
- H Antoine Gout
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Anne C Fledderus
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Department of Dermatology, Erasmus University Medical Center - Sophia Children's Hospital, Erasmus University Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Max M Lokhorst
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Erasmus University Medical Center - Sophia Children's Hospital, Erasmus University Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Corstiaan C Breugem
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Oren Lapid
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Chantal M A M van der Horst
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
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Fledderus AC, Widdershoven AL, Lapid O, Breugem CC, Pasmans SGMA, van der Horst CMAM, Engelen MM, Spuls PI. Neurological signs, symptoms and MRI abnormalities in patients with congenital melanocytic naevi and evaluation of routine MRI-screening: systematic review and meta-analysis. Orphanet J Rare Dis 2022; 17:95. [PMID: 35236387 PMCID: PMC8889704 DOI: 10.1186/s13023-022-02234-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background A congenital melanocytic naevus (CMN) is a rare skin condition that can be associated with abnormalities of the central nervous system (CNS). These anomalies can sometimes cause severe complications, and rarely death. Adequate information about aetiology and management is therefore crucial. To identify how to monitor patients with CMN, we aimed to estimate the prevalence of neurological involvement in patients with CMN and to summarize what specific neurological signs and symptoms and MRI abnormalities are reported in the medical literature. In addition, we summarized and evaluated the recommendations regarding MRI-screening reported in the medical literature. Methods This review was registered in PROSPERO and reported according to the MOOSE checklist. A search was conducted in EMBASE (Ovid), PubMed, and the Cochrane Library. We included studies with 10 or more patients with CMN, reporting on neurological signs and symptoms or CNS MRI. Study selection, data extraction and methodological quality assessment were performed by two independent reviewers. A meta-analysis was used to assess the prevalence of neurological signs and symptoms. Results Out of 1287 studies, fourteen studies were eligible for inclusion of which eight were included in the meta-analysis. Neurological signs and symptoms prevalence was 7.04% (CI 95% 4.47–10.93%) in the meta-analysis group and 6.26% (95% CI 3.85–10%) in a subgroup of patients with a CMN > 6 cm, evaluated in seven studies. Neurodevelopmental delay and seizures were the most frequently reported signs and symptoms. CNS melanocytosis and hydrocephalus were the most frequently reported MRI abnormalities. It was not possible to estimate the increased risk of neurological involvement in patients with CMN due to low quality of evidence and clinical heterogeneity. Conclusion Standardization in CMN studies and a multi-centre prospective study are needed to evaluate neurological involvement. Based on current literature, it is not possible to make strong recommendations on routine MRI-screening. For now, every clinical centre should decide on its own policy and weigh the advantages and disadvantages of routine MRI. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02234-8.
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Affiliation(s)
- Anne C Fledderus
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, 1100 DD, Amsterdam, The Netherlands.
| | - Anna Linn Widdershoven
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Pediatric Neurology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Oren Lapid
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Doctor Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Chantal M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marc M Engelen
- Department of Pediatric Neurology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Fledderus AC, Pasmans SGMA, Wolkerstorfer A, Oei W, Etchevers HC, van Kessel MS, van der Horst CMAM, Spuls PI. Domains and outcomes of the core outcome set of congenital melanocytic naevi for clinical practice and research (the OCOMEN project): part 2. Br J Dermatol 2021; 185:970-977. [PMID: 33959942 PMCID: PMC9290785 DOI: 10.1111/bjd.20437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
Background Congenital melanocytic naevi (CMN) can have a great impact on patients’ lives owing to perceived stigmatization, and the risk of melanoma development and neurological complications. Development of a core outcome set (COS) for care and research in CMN will allow standard reporting of outcomes. This will enable comparison of outcomes, allowing professionals to offer advice about the best management options. In previous research, stakeholders (patients, parents and professionals) reached consensus on the core domains of the COS. To select the appropriate measurement instruments, the domains should be specified by outcomes. Objectives To reach consensus on the specific core outcomes describing the core domains pertaining to clinical care and research in CMN. Methods A list of provisional outcomes (obtained earlier) was critically reviewed by the Outcomes for COngenital MElanocytic Naevi (OCOMEN) research team and by relevant stakeholders through an online questionnaire, to refine this list and provide clear definitions for every outcome. When needed, discussion with individual participants was undertaken over the telephone or by email. During an online consensus meeting, stakeholders discussed the inclusion of potential outcomes. After the meeting, participants voted in two rounds for the inclusion of outcomes. Results Forty‐four stakeholders from 19 countries participated. Nine core outcomes were included in the COS relative to clinical care and 10 core outcomes for research. Conclusions These core outcomes will enable standard reporting in future care and research of CMN. This study facilitates the next step of COS development: selecting the appropriate measurement instruments for every outcome. What is already known about this topic?Congenital melanocytic naevi (CMN) can be associated with psychosocial burden and increased risk of melanoma and/or neurological complications. Outcomes measured for research and care in CMN are heterogeneous, impeding comparison. A core outcome set (COS) may enhance standardized use and reporting, and reduce selective reporting bias. In previous research, relevant stakeholders reached consensus on what domains should be included in the core domain set (CDS).
What does this study add?To select the appropriate measurement instruments for the domains included in the CDS, the domains should be further specified by outcomes. We reached consensus on what outcomes should describe the domains of the CDS of CMN care and research. Through a consensus procedure, including online discussions, online consensus meeting and voting, relevant stakeholders reached consensus on a limited number of core outcomes describing the core domains.
What are the clinical implications of this work?Development of a COS will allow standard reporting of outcomes in future care and research of CMN. This will enable pooling and comparison of outcomes, allowing guideline development of optimal management policy.
Linked Comment: M.V. Heppt et al. Br J Dermatol 2021; 185:881–882. Plain language summary available online
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Affiliation(s)
- A C Fledderus
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands.,Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - W Oei
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - H C Etchevers
- Aix Marseille Univ, INSERM, MMG, Faculté de Médecine AMU, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - M S van Kessel
- Patient representative, Naevus International, the Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
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Heppt MV, Steeb T, Berking C. One set to collect them all? The development of a core domain set for medium-to-giant congenital melanocytic naevi. Br J Dermatol 2021; 185:247-248. [PMID: 33755194 DOI: 10.1111/bjd.19878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M V Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, Erlangen, 91054, Germany.,Comprehensive Cancer Center Erlangen - European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - T Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, Erlangen, 91054, Germany.,Comprehensive Cancer Center Erlangen - European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - C Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, Erlangen, 91054, Germany.,Comprehensive Cancer Center Erlangen - European Metropolitan Region of Nuremberg, Erlangen, Germany
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Oei W, Fledderus AC, Spuls PI, Eggen CAM, Kottner J, van der Horst CMAM, Wolkerstorfer A, van Kessel MS, Krengel S, Etchevers HC, Korfage IJ, Pasmans SGM. Development of an international core domain set for medium, large and giant congenital melanocytic naevi as a first step towards a core outcome set for clinical practice and research. Br J Dermatol 2021; 185:371-379. [PMID: 33237568 DOI: 10.1111/bjd.19694] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Medium, large and giant congenital melanocytic naevi (CMN) can impose a psychosocial burden on patients and families, and are associated with increased risk of developing melanoma or neurological symptoms. Lack of consensus on what outcomes to measure makes it difficult to advise patients and families about treatment and to set up best practice for CMN. OBJECTIVES Fostering consensus among patient representatives and professionals, we aim to develop a core outcome set, defined as the minimum set of outcomes to measure and report in care and all clinical trials of a specific health condition. We focused on the 'what to measure' aspect, the so-called core domain set (CDS), following the COMET and CS-COUSIN guidelines. METHODS We conducted a systematic review to identify outcomes reported in the literature. Focus groups with patient representatives identified patient-reported outcomes. All these outcomes were classified into domains. Through e-Delphi surveys, 144 stakeholders from 27 countries iteratively rated the importance of domains and outcomes. An online consensus meeting attended by seven patient representatives and seven professionals finalized the CDS. RESULTS We reached consensus on six domains, four of which were applied to both care and research: 'quality of life', 'neoplasms', 'nervous system' and 'anatomy of skin'. 'Adverse events' was specific to care and 'pathology' to research. CONCLUSIONS We have developed a CDS for medium-to-giant CMN. Its application in reporting care and research of CMN will facilitate treatment comparisons. The next step will be to reach consensus on the specific outcomes for each of the domains and what instruments should be used to measure these domains and outcomes.
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Affiliation(s)
- W Oei
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - A C Fledderus
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands.,Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - C A M Eggen
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - J Kottner
- Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, D-10117, Germany
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - M S van Kessel
- President Naevus Global, Naevus International Patient Representative Working Group Leader, Utrecht, the Netherlands
| | - S Krengel
- Dermatological Group Practice, Lindenplatz 6, Lübeck, 23554, Germany
| | - H C Etchevers
- Aix Marseille University, INSERM, MMG, Faculté de Médecine, 27 Boulevard Jean Moulin, Marseille, 13005, France
| | - I J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - S G M Pasmans
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
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