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Beck CM, Onyekweli T, Ettinger RE, Boos MD. Facial Soft Tissue Lesions in Children. Oral Maxillofac Surg Clin North Am 2024; 36:247-263. [PMID: 38724424 DOI: 10.1016/j.coms.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Facial soft tissue lesions in children are often classified based on their structure or cellular origin and can be benign or malignant. This review focuses on common facial soft tissue lesions in children, their clinical morphology, natural history, and medical and surgical management, with an emphasis on those considerations unique to soft tissue lesions present at this anatomic site.
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Affiliation(s)
- Christina M Beck
- Division of Plastic and Reconstructive Surgery, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, University of Washington, 325 9th Avenue Box 359796, Seattle, WA 98104, USA
| | - Tito Onyekweli
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15212, USA
| | - Russell E Ettinger
- Division of Plastic and Reconstructive Surgery, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sand Point Way Northeast, OC.9.833, Seattle, WA 98105, USA.
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2
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Tan S, Hu H, Li G, Zhao J, Wu D. Prevalence, incidence density and standardized morbidity rate of melanoma among patients with congenital melanocytic naevi: a systematic review. Clin Exp Dermatol 2024; 49:765-773. [PMID: 38380707 DOI: 10.1093/ced/llae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/30/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Congenital melanocytic naevi (CMN) are the result of aberrations in the mitogen-activated protein kinase signal transduction pathway. The risk of melanoma is the most important concern among patients with CMN because of its poor prognosis. However, as a result of the great variability between studies, the reported risk of melanoma varies considerably, making it difficult to provide reliable information. OBJECTIVES To evaluate the prevalence, incidence density and standardized morbidity ratio (SMR) of melanoma among patients with CMN. METHODS We conducted a systematic literature search of studies providing data on the risk of melanoma in patients with CMN following our registered and published protocol (PROSPERO: CRD42022383009). RESULTS Overall, 27 studies with a total of 11 480 patients with CMN and 82 patients developing melanoma were included for analysis. The prevalence of melanoma was 1.84% [95% confidence interval (CI) 1.13-2.99] in patients with CMN and 2.73% (95% CI 1.67-4.43) in the subgroup of patients with large CMN (LCMN). The incidence of melanoma was 237.56 (95% CI 97.79-575.96) per 100 000 person-years in patients with CMN and 585.73 (95% CI 315.39-1085.29) per 100 000 person-years in the LCMN subgroup. The SMR of melanoma was 122.27 (95% CI 11.84-1262.88) among all patients with CMN and 285.97 (95% CI 50.65-1614.59) in the subgroup of patients with LCMN. CONCLUSIONS Our research suggests that the risk of melanoma in the CMN population seems to have been overestimated in previous studies, but it is still significantly higher than that in the general population. In addition to the risk of melanoma, aesthetic improvement and mental health should also be taken into account when making management decisions.
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Affiliation(s)
- Songtao Tan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan, Beijing, China
| | - Haoyue Hu
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
- United Laboratory of Frontier Radiotherapy Technology of Sur Yat-sen University and Chinese Academy of Sciences lon Medical Technology Co, Guangzhou, China
| | - Guiying Li
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan, Beijing, China
| | - Jiaqi Zhao
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan, Beijing, China
| | - Di Wu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan, Beijing, China
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Sagar M, Tandan N, Kumar R, Kumar R. Treatment of congenital melanocytic naevi of nose using multiple flaps in single stage in a paediatric patient and literature review. BMJ Case Rep 2024; 17:e260577. [PMID: 38782429 DOI: 10.1136/bcr-2024-260577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
A girl in her middle childhood presented to the outpatient department (OPD) with a congenital melanocytic naevi (CMN) of the right nasal alar lobule. Her parents had aesthetic concerns and expressed their desire to get the lesion removed. The full-thickness excision of CMN was performed with the reconstruction of the defect using the nasolabial and dorsal nasal advancement flap with conchal cartilage to shape the contour of the ala.
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Affiliation(s)
- Milind Sagar
- Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nisha Tandan
- Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Zhao Y, Zou Y, Chen H, Rao Y, Lin X. Erbium: YAG laser treatment efficacy and association with histologic features for giant congenital melanocytic nevi management. Lasers Surg Med 2024; 56:361-370. [PMID: 38506244 DOI: 10.1002/lsm.23776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/30/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Limited research exists on laser treatment of giant congenital melanocytic nevus (GCMN). OBJECTIVE We sought to elucidate the efficacy of the Erbium: YAG laser on GCMN and the histologic factors associated with a positive clinical response. METHODS AND MATERIALS Between 2019 and 2022, we enrolled 30 medium-to-giant CMN patients who underwent Er: YAG laser treatment. All patients received biopsies before and after laser treatments. Clinical efficacy outcomes were evaluated by the investigator's global assessment (IGA), 5-point scale of depigmentation, and Vancouver Scar Scale (VSS) scores at least 6 months after treatment. RESULTS Of the 30 cases, 18 (60.0%) showed improvement (IGA score ≥3). Eight (26.7%) patients showed repigmentation. Eight (26.7%) patients developed hypertrophic scars. The average IGA, depigmentation, and VSS scores were 2.93, 3.57, and 3.20. The IGA score was higher (3.24 ± 1.18 vs. 2.22 ± 0.97, p = 0.031) and a lower repigmentation rate (14.3% vs. 55.6%, p = 0.032) was observed in the cases with Grenz zone. The IGA score was higher (3.33 ± 1.24 vs. 2.13 ± 0.89, p = 0.023) and the repigmentation rate was lower (11.1% vs. 50.0%, p = 0.034) also in the cases with the melanocytes nests with aggregation of melanin. Lesions with superficial ablation resulted in less hypertrophic scar formation than those with deep ablation (5.9% vs. 53.8%, p < 0.05). CONCLUSION The Er: YAG laser demonstrated effective clinical results for GCMNs. The grenz zone and the melanocytes nests with aggregation of melanin are promising predictors of laser efficacy.
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Affiliation(s)
- Yifei Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yun Zou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hui Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yamin Rao
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Kim JY, Lee SY, Kwak Y, Kim BJ. Thickness of melanocytes in giant congenital melanocytic nevus for complete surgical excision: clinicopathological evaluation of 117 lesions according to the area and size. BMC Surg 2024; 24:90. [PMID: 38491443 PMCID: PMC10941407 DOI: 10.1186/s12893-024-02362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/17/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Giant congenital melanocytic nevi (GCMN) are usually defined as nevi that exceed 20 cm in maximal diameter or 15% of the total body surface area. There have been reports of life-long malignant change risks arising from GCMN, leading to surgical excision of GCMN. This study aims to evaluate the thickness of melanocytes based on clinical factors in order to provide objective information for the complete resection of the lesion. METHODS Overall, 75 patients diagnosed with GCMN between 2000 and 2021 were included, and their clinical records were collected retrospectively. 117 pathologic slides obtained during excision were reviewed to measure nevus thickness. Clinical factors were assessed with a generalized estimated equation model for association with nevus thickness. RESULTS The thickness of nevus was significantly associated with the location and size. Nevus thickness was more superficial in the distal extremity than in the head and trunk (P = 0.003 [head]; P < 0.001 [trunk]; P = 0.091 [Proximal extremity]). Nevi sized 60 cm or more were significantly deeper than those measuring 20-29.9 cm (P = 0.035). An interaction between size and location existed (P < 0.001). Trunk and distal extremity lesions consistently exhibited uniform thickness regardless of lesion size, whereas head and proximal extremity lesions showed variations in thickness based on lesion size. CONCLUSION GCMNs have differences in thickness according to location and size. Therefore, it is necessary to devise an approach optimized for each patient to treat GCMN. In the study, it was emphasized that the thickness of GCMN is correlated with clinical factors, specifically the location and size of the nevus. Consequently, these findings underscore the need for individualized treatment plans for effective surgical intervention.
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Affiliation(s)
- Ji-Young Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Se Yeon Lee
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Jin F, Li X, Chen J, Liu J, Wang Y. Clinical study on the role of platelet-rich plasma in human acellular dermal matrix with razor autologous skin graft repair of giant congenital pigmented nevus in children. J Plast Reconstr Aesthet Surg 2024; 90:305-314. [PMID: 38394838 DOI: 10.1016/j.bjps.2024.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND NA OBJECTIVE: Evaluate the safety and feasibility of platelet-rich plasma (PRP) in the treatment of giant congenital melanocytic nevi (GCMN) in children with human acellular dermal matrix (HADM) transplantation. PATIENTS AND METHODS A total of 22 children with GCMN were included in the study. They were divided into an experimental and a control group. The experimental group used the method of HADM with Razor Autologous Skin Graft combined with PRP to repair skin and soft tissue defects after giant nevus resection (Group A, n = 11). The control group was treated with HADM with Razor Autologous Skin Graft (Group B, n = 11) only. To compare the survival rate of skin grafts, we used the Vancouver Scar Scale (VSS) for the postoperative skin graft area and the Patient and Observer Scar Assessment Scale (POSAS) to compare the two groups of patients. RESULTS There was no statistically significant difference in age, gender, location of giant nevi, and pathological classification between Group A and Group (P > 0.05). The survival rate of skin grafting and the VSS and POSAS scores of scar tissue in group A were superior to those of group B (P < 0.05). CONCLUSIONS PRP has improved the survival rate of composite skin grafting in children with GCMN, and long-term satisfactory prognosis of scar healing. Therefore, we consider this treatment method a valuable contribution to clinical practice.
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Affiliation(s)
- Fei Jin
- Department of Burns and Plastic Surgery, Beijing Children Hospital, National Center of Children's Health, Beijing Children Hospital, Capital Medical University, Beijing City, China
| | - Xiang Li
- Department of Burns and Plastic Surgery, Beijing Children Hospital, National Center of Children's Health, Beijing Children Hospital, Capital Medical University, Beijing City, China
| | - Jigang Chen
- Department of Burns and Plastic Surgery, Beijing Children Hospital, National Center of Children's Health, Beijing Children Hospital, Capital Medical University, Beijing City, China
| | - Jing Liu
- Department of Burns and Plastic Surgery, Beijing Children Hospital, National Center of Children's Health, Beijing Children Hospital, Capital Medical University, Beijing City, China
| | - Yining Wang
- Department of Burns and Plastic Surgery, Beijing Children Hospital, National Center of Children's Health, Beijing Children Hospital, Capital Medical University, Beijing City, China.
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Mologousis MA, Tsai SYC, Tissera KA, Levin YS, Hawryluk EB. Updates in the Management of Congenital Melanocytic Nevi. CHILDREN (BASEL, SWITZERLAND) 2024; 11:62. [PMID: 38255375 PMCID: PMC10814732 DOI: 10.3390/children11010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
Congenital melanocytic nevi (CMN) carry an increased risk of melanoma and may be disfiguring, and consensus regarding treatment recommendations is lacking. While clinical monitoring is the standard of care, many caregivers are interested in its removal to prevent psychosocial burden or to decrease risk. Although melanoma can occur regardless of CMN removal, there are a variety of treatments that may offer improved cosmesis or local symptom control, including surgical excision, laser therapy, and other superficially destructive techniques. Regardless of the selected management, these patients are monitored for ongoing melanoma risk. An extensive discussion with families regarding the risks and benefits of observation versus active intervention is essential. To facilitate these discussions, we herein summarize current CMN management strategies and considerations.
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Affiliation(s)
- Mia A. Mologousis
- School of Medicine, Tufts University, Boston, MA 02111, USA
- Dermatology Program, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Serena Yun-Chen Tsai
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Harvard University, Boston, MA 02115, USA
| | - Kristin A. Tissera
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Duke University, Durham, NC 27710, USA
| | - Yakir S. Levin
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Harvard University, Boston, MA 02115, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Elena B. Hawryluk
- Dermatology Program, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Harvard University, Boston, MA 02115, USA
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Tan S, Hu H, Xin X, Wu D. A clinical and biologic review of congenital melanocytic nevi. J Dermatol 2024; 51:12-22. [PMID: 37955315 DOI: 10.1111/1346-8138.17025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
Congenital melanocytic nevi (CMN) are the result of aberrations in the mitogen-activated protein kinase signal transduction pathway caused by postzygotic somatic mutations. The estimated incidence of newborns with CMN is 1%-2%. The main complications of CMN include proliferative nodules, melanomas, and neurocutaneous melanosis, and the latter two are the most troublesome issues to address. Treatments are primarily taken into account for aesthetic purposes and the reduction of melanoma risk. Due to the much lower incidence of malignant transformation observed in recent studies than in previous data, clinical management paradigms for CMN patients have gradually shifted towards conservative observation and close monitoring. Surgery and lasers are still the main treatments, and targeted therapy may be a promising strategy to help manage complications. With the increase in awareness of mental health, increasing focus has been placed on the quality of life (QoL) and psychological issues of both CMN patients and their parents. Recent studies have revealed that families coping with CMN might endure intense pressure, a major loss in QoL, and psychological problems after diagnosis and during treatment. Here, we sought to present an overview of genetic basis, complications, treatments, and psychological issues related to CMN and hope to provide better management for patients with CMN.
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Affiliation(s)
- Songtao Tan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoyue Hu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin Xin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Wu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ibelli TJ, Bauer B, Kleinman EP, Kuruvilla A, Mendiratta D, Scope A, Seyidova N, Taub PJ. Surgery or Not? A Systematic Review of Facial Congenital Melanocytic Nevi Treatment Patterns and Outcomes. Ann Plast Surg 2024; 92:120-132. [PMID: 37856246 DOI: 10.1097/sap.0000000000003676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Treatment management for congenital melanocytic nevi (CMN) on the face (FCMN) is highly variable and requires a thorough assessment of multiple factors. To date, a systematic review of FCMN treatment is lacking. The purpose of the present study was to elucidate the frequency, variety, and outcomes of treatment modalities for FCMN with different levels of complexity. METHODS A comprehensive review of Pubmed, Embase, and Google Scholar databases from 1950 to 2022 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles reporting on FCMN treatment approaches, outcomes, and associated complications were screened and data were extracted according to inclusion criteria. Data were tabulated for thematic analysis of FCMN treatment types, anatomic locations, outcomes, and complications. RESULTS Of the 561 studies retrieved, 34 met inclusion criteria including 19 surgical treatments, 14 nonsurgical treatments, and one combined surgical and nonsurgical treatment study, totaling 356 patients. The majority of treated FCMN were small-to-medium-sized (56%). Facial CMN treated conservatively were mostly located on the cheek (27%) and/or perinasal region (21%), whereas FCMN treated with surgery were primarily located in the periorbital region (44%) and/or the cheek (17%). Across all treatment cohorts, 22% of patients experienced at least one complication, with 12% of complications experienced by patients treated by surgery. CONCLUSIONS There is a greater need for standardized FCMN nomenclature that encompasses nevi pattern, dimensions, anatomical coverage, and quantitative measurements of treatment outcome. Future studies should focus on identifying anatomic locations of FCMN that are more prone to complications and determine which treatment approach optimizes outcomes.
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Affiliation(s)
| | - Bruce Bauer
- Department of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Elana P Kleinman
- From the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Annet Kuruvilla
- Division of Plastic and Reconstructive Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | - Dhruv Mendiratta
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | | | - Nargiz Seyidova
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Yamanaka H, Sawaragi E, Nakano T, Katayama Y, Ito T, Tada H, Hidaka Y, Morita S, Funakoshi C, Kinoshita A, Watanabe M, Tsuge I, Katsube M, Sakamoto M, Yamaoka T, Morimoto N. A high-hydrostatic pressure device for nevus tissue inactivation and dermal regeneration for reconstructing skin defects after giant congenital melanocytic nevus excision: a clinical trial. Regen Ther 2023; 24:167-173. [PMID: 37448852 PMCID: PMC10338193 DOI: 10.1016/j.reth.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/08/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Background A novel treatment has been developed to reconstruct large skin defects caused by the excision of giant congenital melanocytic nevi. It involves the reimplantation of high-hydrostatic pressurized nevus tissue as a cell-inactivated autologous scaffold for dermal regeneration, followed by the implantation of cultured epithelial autografts on the regenerated dermis. Because this treatment has shown promise in a first-in-human clinical trial which used a prototype pressure machine, a novel pressure device was specifically designed for clinical use. Methods In a prospective investigator-initiated clinical trial involving three patients, we evaluated the safety and efficacy of the skin regeneration treatment using a pressure device. All three patients underwent surgical excision of the nevus tissue, primary reimplantation of the inactivated nevus tissue, and secondary implantation of cultured epithelial autografts. Results Engraftment of inactivated nevus tissue and cultured epithelial autografts was successful in all three cases, with over 90% epithelialization at 8 weeks post-surgery. No serious adverse events or device malfunction were observed during the trial. Conclusion The novel pressure device safely and effectively enabled dermal regeneration using the nevus tissue as an autologous scaffold. This innovative approach offers several advantages, including reduced invasiveness due to minimal sacrifice of normal skin for skin grafting and high curative potential resulting from full-thickness removal of the nevus tissue.
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Affiliation(s)
- Hiroki Yamanaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Eiichi Sawaragi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takashi Nakano
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yasuhiro Katayama
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tatsuya Ito
- Regulatory Science and Pharmaceutical Informatics, School of Pharmaceutical Sciences, Wakayama Medical University, 25-1 Nanabancho, Wakayama, Wakayama Prefecture 640-8156, Japan
| | - Harue Tada
- Department of Clinical Trial Science, Translational Research Center, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yu Hidaka
- Department of Clinical Trial Science, Translational Research Center, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Satoshi Morita
- Department of Clinical Trial Science, Translational Research Center, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Chihiro Funakoshi
- Department of Clinical Trial Science, Translational Research Center, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akemi Kinoshita
- Department of Clinical Trial Science, Translational Research Center, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Mieko Watanabe
- Department of Clinical Trial Science, Translational Research Center, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Motoki Katsube
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Michiharu Sakamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tetsuji Yamaoka
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shinmachi, Suita, Osaka 564-8565, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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11
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Schwenk L, Graf J, Kofler K, Häfner HM, Kofler L. Surgical Therapy of Congenital Nevi in the First Year of Life-Psychological Impact on Parents. J Cutan Med Surg 2023; 27:608-613. [PMID: 37735715 PMCID: PMC10714692 DOI: 10.1177/12034754231199750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/17/2023] [Accepted: 07/30/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The birth of a child with a congenital melanocytic nevus (CMN) can lead to distress in the parents. Surgical treatment of CMN can begin in infancy. OBJECTIVES To provide insight into the perspective of parents of children with CMN regarding their experienced psychological burden and motivation to undergo surgery as well as their satisfaction. METHODS Retrospective analysis of patient data of infants (< 1 year of age), who were surgically treated by power stretching for CMN using subcutaneous infiltration anesthesia (SIA) from 01/01/2020 to 08/31/2021. To evaluate the parent's motivation and psychological burden during the surgical treatment of their child, a questionnaire was designed to interview them in a standardized telephone-based interview. RESULTS Out of 45 interviewed parents, 62.2% indicated "severe" or "very severe" distress at the time of their child's birth. Distress was mostly reduced by information about diagnosis and treatment (n = 34) and treatment-progress (n = 27). Stigmatization was experienced by 35.6% of parents. 84,5% of parents were highly satisfied with early initiation of surgical therapy. 69% felt "very satisfied" or "satisfied" with the outcome of surgery. Motivation for surgical therapy was concern about malignant transformation of the, possible stigmatization of the child due to the nevus, while most of the parents (73.3%) mentioned both. CONCLUSIONS Surgical treatment of CMN by power stretching in SIA in infancy is associated with high levels of satisfaction among the children's parents. Early initiation of surgical therapy and education about the diagnosis can reduce the psychological burden of the parents and can prevent psychosocial problems in affected children.
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Affiliation(s)
- Lena Schwenk
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
| | - Johanna Graf
- Internal Medicine VI Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Psychooncology Section, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Katrin Kofler
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Center for Skin Diseases skin+more MVZ, Biberach a.d.R., Germany
| | - Hans-Martin Häfner
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Center for Rare Skin Diseases, Eberhard Karls University, Tuebingen, Germany
| | - Lukas Kofler
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Center for Skin Diseases skin+more MVZ, Biberach a.d.R., Germany
- Center for Rare Skin Diseases, Eberhard Karls University, Tuebingen, Germany
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12
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Dung PTV, Son TT, Thuy TTH, Duy TT. Serial excision surgery for giant dorsal congenital melanocytic nevus: Case report. Int J Surg Case Rep 2023; 106:108152. [PMID: 37098292 PMCID: PMC10149246 DOI: 10.1016/j.ijscr.2023.108152] [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: 02/19/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/27/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Giant congenital melanocytic nevus increases the risk of melanoma and seriously affects the aesthetics and psychology of patients, influencing the personality development of children. CASE PRESENTATION A 7-year-old female child presented with a giant congenital melanocytic nevus on the back, which extended from the right anterior abdominal wall to the left flank Taking advantage of the elasticity of children's skin, we performed serial excision and obtained favourable results. The procedure included seven surgeries, and the average interval between the surgeries was 7 months. The nevus was partially resected from the periphery to the centre, and the direction of excision of the nevus depended on the mobilisation of the surrounding normal skin, including from the shoulder downward, lateral to medial, and from the bottom upward. After the seventh surgery at 11 years of age, the nevus was completely removed, and there were no complications. CLINICAL DISCUSSION Serial excision is a simple and less invasive surgical technique that can achieve both complete excision and a satisfactory aesthetic result for giant congenital melanocytic nevus. The giant nevus of the back can be removed completely after several procedures due to the very good elasticity of the skin and the great ability of natural expansion of healthy skin under a considerable stretching force in children. CONCLUSION Serial excision is an effective method for treating dorsal giant congenital melanocytic nevus in children because of excellent natural skin elasticity.
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Affiliation(s)
- Pham Thi Viet Dung
- Plastic Surgery Department, Hanoi Medical University, Hanoi, Viet Nam; Plastic Reconstructive and Aesthetic Surgery Department, Bach Mai Hospital, Hanoi, Viet Nam.
| | - Tran Thiet Son
- Plastic Surgery Department, Hanoi Medical University, Hanoi, Viet Nam; Plastic Reconstructive and Aesthetic Surgery Department, Bach Mai Hospital, Hanoi, Viet Nam.
| | - Ta Thi Hong Thuy
- Plastic Surgery Department, Hanoi Medical University, Hanoi, Viet Nam; Plastic Reconstructive and Aesthetic Surgery Department, Bach Mai Hospital, Hanoi, Viet Nam.
| | - Truong The Duy
- Plastic Reconstructive and Aesthetic Surgery Department, Bach Mai Hospital, Hanoi, Viet Nam
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13
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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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14
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Cheng X, He Y, Bao W, Zhang Z, Chen L, Song G, Lan J, Xu F, Jia C, Dai T. Transcriptomic analysis of mRNA expression in giant congenital melanocytic nevi. Gene 2022; 850:146894. [PMID: 36174903 DOI: 10.1016/j.gene.2022.146894] [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: 03/31/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE GCMN is a sporadic disease with an incidence ranging from 1/20,000 to 1/500000. So far, several studies have found that GCMN is related to somatic mutations, but most of them have focused on known pathogenic genes, and transcriptome sequencing based on large datasets is relatively uncommon. At present, the use of next-generation sequencing technologies and bioinformatics platforms makes genomic information study more comprehensive and efficient. In this study, the transcriptome differences between GCMN lesions and surrounding normal skin tissues were investigated using high-throughput transcriptome sequencing, and hub genes and pathways related to pathogenesis were identified, providing a theoretical foundation for further research into the pathogenesis of GCMN. METHODS Pathological skin tissue and surrounding normal skin tissue from GCMN patients, namely the pathological group (PG) and the control group (CG), were obtained. 1. All specimens were stained with HE to ensure that the samples met the experimental requirements. 2. Ten pairs of specimens were selected for high-throughput transcriptome sequencing, and the differentially expressed genes (DEGs) between the PG and the CG were obtained. The DEGs were analyzed by clusterProfiler R software for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. The function of the subnetwork was analyzed and the hub genes were identified by the STRING database and Cytoscape software. 3. The expression differences of hub genes PTGS2, EGF, and SOX10 in pathological skin tissues and normal skin tissues were verified by qRT-PCR and immunofluorescence staining. RESULTS 1. HE staining revealed a lot of melanocytes in the dermis and subcutaneous tissues. They were found around the hair follicles, sweat glands, sebaceous glands, and blood vessel walls, or in a specific pattern. 2. The screening threshold was set at p<0.01 and |log2fc|<1, and a total of 1163 DEGs were discovered between the PG and CG, with 519 genes up-regulated and 644 genes down-regulated in the pathological tissues. According to the GO functional analysis, 29 biological processes, 18 cell compositions, and 17 molecular functions were significantly enriched, with the majority of them being related to keratinocytes and the extracellular matrix. There were 779 nodes and 2359 interactions in the protein interaction network. Using the MCODE plug-in, the network was divided into 25 functional clusters. According to ClueGO results, Cluster5 was involved in melanin biosynthesis and melanocyte proliferation. Using 11 operation methods in the Cytohubba plug-in, PTGS2, EGF, and SOX10 in Cluster5 were chosen as hub genes. 3. qRT-PCR and immunofluorescent staining revealed that compared to normal skin tissue, the expression of SOX10 was significantly up-regulated, and the expression of PTGS2 and EGF was significantly down-regulated in pathological skin tissue(P<0.001). CONCLUSIONS In GCMN, keratinocytes and extracellular matrix may directly and indirectly affect melanocyte activity. PTGS2, EGF, and SOX10 are important genes and significantly differentially expressed in pathological and normal skin tissues. These findings may serve as a springboard for future research.
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Affiliation(s)
- Xialin Cheng
- Department of Burns and Plastic Surgery, Xiang'an Hospital of Xiamen University, Xiamen, China, 2000 East Xiang 'an Road, Xiang 'an District, Xiamen city, China.
| | - Yan He
- Department of Burns and Plastic Surgery, Xiang'an Hospital of Xiamen University, Xiamen, China, 2000 East Xiang 'an Road, Xiang 'an District, Xiamen city, China.
| | - Wu Bao
- Department of Burns and Plastic Surgery, Xiang'an Hospital of Xiamen University, Xiamen, China, 2000 East Xiang 'an Road, Xiang 'an District, Xiamen city, China.
| | - Zexin Zhang
- Department of Burns and Plastic Surgery, Xiang'an Hospital of Xiamen University, Xiamen, China, 2000 East Xiang 'an Road, Xiang 'an District, Xiamen city, China.
| | - Lingxi Chen
- Department of Burns and Plastic Surgery, Xiang'an Hospital of Xiamen University, Xiamen, China, 2000 East Xiang 'an Road, Xiang 'an District, Xiamen city, China.
| | - Ge Song
- Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology 24 Jinghua Road, Jianxi District, Luoyang city, Henan Province.
| | - Junhong Lan
- Department of Burns and Plastic Surgery, Xiang'an Hospital of Xiamen University, Xiamen, China, 2000 East Xiang 'an Road, Xiang 'an District, Xiamen city, China.
| | - Fangfang Xu
- Department of Burns and Plastic Surgery, Xiang'an Hospital of Xiamen University, Xiamen, China, 2000 East Xiang 'an Road, Xiang 'an District, Xiamen city, China.
| | - Chiyu Jia
- Department of Burns and Plastic Surgery, Xiang'an Hospital of Xiamen University, Xiamen, China, 2000 East Xiang 'an Road, Xiang 'an District, Xiamen city, China.
| | - Tao Dai
- Department of Plastic Surgery, the Third Affiliated Hospital, Henan University of Science and Technology, Luoyang, China 36 Xiyuan Road, Jianxi District, Luoyang city, Henan Province.
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15
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Kim JY, Jeon JH, Choi TH, Kim BJ. Risk of Malignant Transformation Arising From Giant Congenital Melanocytic Nevi: A 20-year Single-center Study. Dermatol Surg 2022; 48:171-175. [PMID: 34935754 DOI: 10.1097/dss.0000000000003341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although giant congenital melanocytic nevus (GCMN) is regarded as premalignant, the incidence and risk factors of malignant transformation are controversial. OBJECTIVE This study aimed to share the authors' surgical experience with GCMNs and provide data on their demographics, malignant transformation, and prognosis. METHODS This single-center, consecutive study included 152 patients with GCMN who visited this center from March 2000 to February 2020. Their medical documentation was reviewed retrospectively, and the nevi were classified according to the size as follows: Group 1, 10 to 19.9 cm (n = 45); Group 2, 20 to 39.9 cm (n = 62); and Group 3, ≥40 cm (n = 45). RESULTS Seven malignancies were found (4.6%; 4 melanomas, 2 rhabdomyosarcomas [RMS], and 1 malignant peripheral nerve sheath tumor [MPNST]). The risk increased according to the nevus size (2.2% in Group 1, 3.2% in Group 2, and 8.9% in Group 3) but the difference was not statistically significant (p = .3305). CONCLUSION Malignant transformation from GCMN cannot be ignored. It can include transformation into melanoma, RMS, and MPNST. Early surgical resection and regular follow-up should be performed in patients with nevi ≥10 cm.
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Affiliation(s)
- Ji-Young Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hui Jeon
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyun Choi
- The Nevus Plastic Surgery Clinic, Seoul, Republic of Korea
| | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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16
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Jahnke MN, O'Haver J, Gupta D, Hawryluk EB, Finelt N, Kruse L, Jen M, Horii KA, Frieden IJ, Price H, Coughlin CC. Care of Congenital Melanocytic Nevi in Newborns and Infants: Review and Management Recommendations. Pediatrics 2021; 148:183438. [PMID: 34845496 DOI: 10.1542/peds.2021-051536] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 01/06/2023] Open
Abstract
A pediatric dermatology expert working group performed a narrative review to describe care related to congenital melanocytic nevi (CMN) in neonates and infants. There are no published guidelines for most aspects of care, including routine skin care and visit intervals. Few guidelines exist for surgical management; newer recommendations favor conservative practice. Emerging evidence contributes to recommendations for screening MRI to evaluate for neural melanosis and related central nervous system complications, however, more research is needed. Risk for melanoma is generally low, but those with large, giant, or multiple CMN have a higher risk. Multidisciplinary care, with a focus on family and patient preferences, is of paramount importance. Without standardized screening and management guidelines, questions abound regarding appropriate physical examination intervals, potential treatment including full or partial excision, timing and frequency of imaging, melanoma risk, and assessment for neural melanosis. This review highlights the current state of knowledge concerning care of patients with CMN, reveals gaps in the literature surrounding skin care, and provides management recommendations. We additionally discuss cutaneous complications of CMN, such as pruritus, hypertrichosis, and wound healing. Resources and references for families and providers can help patients navigate this sometimes challenging diagnosis. Finally, we contribute expert care recommendations to the current body of literature as a foundation for the development of future, more comprehensive care guidelines.
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Affiliation(s)
- Marla N Jahnke
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Judith O'Haver
- Division of Dermatology, Phoenix Children's Hospital and College of Medicine, University of Arizona-Phoenix, Phoenix, Arizona
| | - Deepti Gupta
- Division of Dermatology, Seattle Children's Hospital, Seattle, Washington
| | - Elena B Hawryluk
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Nika Finelt
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Lacey Kruse
- Division of Dermatology, Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Melinda Jen
- Section of Pediatric Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kimberly A Horii
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri
| | - Ilona J Frieden
- Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Harper Price
- Division of Dermatology, Phoenix Children's Hospital and College of Medicine, University of Arizona-Phoenix, Phoenix, Arizona
| | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, School of Medicine, Washington University in St Louis, St Louis, Missouri
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17
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Soong LC, Bencivenga A, Fiorillo L. Neonatal Curettage of Large to Giant Congenital Melanocytic Nevi Under Local Anesthetic: A Case Series With Long-Term Follow Up. J Cutan Med Surg 2021; 26:149-155. [PMID: 34792421 PMCID: PMC8950714 DOI: 10.1177/12034754211057751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Neonatal curettage of large to giant congenital melanocytic nevi (L-GCMN) is a simple, minimally invasive procedure typically performed within the first 2 weeks of life. Objectives To retrospectively review our experience with serial curettage of L-GCMN in the neonatal period performed under local anesthesia and their long-term outcomes. Methods Curettage was performed by a single pediatric dermatologist on nine neonates with L-GCMN under local anesthetic and with oral analgesia between 2002 and 2016 in Red Deer, Alberta, Canada. Patient charts were reviewed retrospectively to assess patient and procedure characteristics, tolerability, safety, cosmetic and functional outcomes, and malignant transformation. Results Patients were treated with an average of 6 curettage sessions (range 3 to 15) to remove the majority or entirety of the nevus. All patients tolerated local anesthesia well. The most common adverse event of the procedure was transient neutropenia. Two patients developed positive bacterial cultures without clinical signs of infection, treated with antibiotics. All curetted specimens demonstrated benign pathology. Patients were followed annually thereafter, for an average of 6 years. Eight patients with L-GCMN of the trunk had minimal to partial repigmentation with good cosmetic outcome. One patient had recurrence of a facial nevus. None of the patients developed cutaneous malignant melanoma. Conclusions Curettage appears to be a safe and effective treatment option for select cases of L-GCMNs of the trunk. We do not recommend the procedure for face or scalp CMN. This procedure can be performed under local anesthesia with serial curettage to avoid potential risks of general anesthesia.
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Affiliation(s)
- Laura C Soong
- 3158 Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Loretta Fiorillo
- 3158 Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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18
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Carmen Ceballos-Rodríguez M, Redondo P, Tomás-Velázquez A, Cieza-Díaz D, Carlos López-Gutiérrez J. Surgical outcomes and psychosocial impact of giant congenital melanocytic nevus surgery: A single-center case series of 136 patients. J Pediatr Surg 2021; 56:2113-2117. [PMID: 33461742 DOI: 10.1016/j.jpedsurg.2020.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/24/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the outcomes, complications and psychosocial impact of surgical treatment of giant congenital melanocytic nevus (GCMN). METHODS Patients with surgically treated GCMN who attended our clinic between May 2014 and May 2018 were included. Patient demographics and data on the characteristics of the nevus, surgical treatment, and the psychosocial impact (including C-DLQI/DLQI questionnaires) were collected. RESULTS One hundred thirty-six patients were included (median age 9 years). Mean age at first surgery was 34 (+/- 61.45) months; 5.53 (+/- 3.69) surgical interventions were necessary to completely excise the nevus. The expanded skin flap was the preferred surgical technique in most locations. Complications were common but not severe. Of the patients studied, 70.4% reported that the surgery had a minor impact on their quality of life (QoL). Patients and caregivers stated that surgical treatment should begin as soon as possible, even in cases where early treatment did not have an impact on their QoL nor on their satisfaction with the surgery (p < 0.05). The lower the patient age at first surgery, the higher the surgeon's satisfaction (p < 0.01). CONCLUSIONS Surgical treatment is a safe option for management of GCMN, and has a low impact on QoL. Patients, caregivers, and surgeons agree that the treatment should begin as soon as possible. This is the largest single-center study evaluating surgical treatment in GCMN patients and its psychosocial impact, and the first to take into account the patient, caregivers and dermatologists opinion of surgical results.
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Affiliation(s)
- María Carmen Ceballos-Rodríguez
- Department of Dermatology, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos 2, 28040 Madrid, Spain.
| | - Pedro Redondo
- Department of Dermatology, Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Navarra, Spain
| | - Alejandra Tomás-Velázquez
- Department of Dermatology, Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Navarra, Spain
| | - Deysy Cieza-Díaz
- Department of Dermatology, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos 2, 28040 Madrid, Spain
| | - Juan Carlos López-Gutiérrez
- Department of Pediatric Surgery, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
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Morimoto N, Mitsui T, Katayama Y, Kakudo N, Ogino S, Tsuge I, Sakamoto M, Hihara M, Kusumoto K. Cultured epithelial autografts for the treatment of large-to-giant congenital melanocytic nevus in 31 patients. Regen Ther 2021; 18:217-222. [PMID: 34377751 PMCID: PMC8313801 DOI: 10.1016/j.reth.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Giant congenital melanocytic nevus (GCMN) is a large melanocytic nevus, and its full-thickness removal is usually difficult due to the lack of skin available for reconstruction. Curettage is an alternative approach in cases of GCMN to remove the superficial dermis above the cleavage plane with a curette in the neonatal period, and its major complications include repigmentation, retarded epithelization, and hypertrophic scar formation. In Japan, the JACE® cultured epidermal autograft (CEA) was approved and covered by public healthcare insurance for the treatment of congenital melanocytic nevus (CMN) that is difficult to treat with conventional methods in 2016. We have used CEA for wounds after curettage in the neonatal period or following ablation after the neonatal period in combination with laser therapies to reduce the above-mentioned complications. Methods In this study, we summarized all consecutive CMN patients treated using CEA from December 2016 to April 2019 and evaluated the duration required for epithelialization, incidence of hypertrophic scar, and color change in the target nevus by comparing the L∗ values one year later between the Curettage group, the non-Curettage group with initial treatment or the subsequent group. Results No significant differences were seen in the epithelization period or incidence of hypertrophic scars among the groups, but the color of the target nevus was improved significantly in the Curettage group (p < 0.01) and non-Curettage group with initial treatment (p < 0.01). Conclusions In conclusion, CEA seems to accelerate epithelization after curettage or ablation of CMN, and this treatment could improve the color of CMN when applied initially.
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Affiliation(s)
- Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
- Corresponding author. 54,Kawahara-cho Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. Fax: + 81-75-751-4340
| | - Toshihito Mitsui
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
| | - Yasuhiro Katayama
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
| | - Natsuko Kakudo
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
| | - Shuichi Ogino
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
| | - Michiharu Sakamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
| | - Masakatsu Hihara
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
| | - Kenji Kusumoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
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20
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A Novel Treatment for Giant Congenital Melanocytic Nevi Combining Inactivated Autologous Nevus Tissue by High Hydrostatic Pressure and a Cultured Epidermal Autograft: First-in-Human, Open, Prospective Clinical Trial. Plast Reconstr Surg 2021; 148:71e-76e. [PMID: 34181614 DOI: 10.1097/prs.0000000000008084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Giant congenital melanocytic nevi are large skin lesions associated with a risk of malignant transformation. The authors developed a novel treatment to reconstruct full-thickness skin defects by combining an inactivated nevus as the autologous dermis and a cultured epidermal autograft. The first-in-human trial of this treatment was performed. METHODS Patients with melanocytic nevi that were not expected to be closed by primary closure were recruited. The full-thickness nevus of the target was removed and inactivated by high hydrostatic pressurization at 200 MPa for 10 minutes. The inactivated nevus was sutured to the original site, and a cultured epidermal autograft was grafted onto it 4 weeks later. Patients were followed for up to 52 weeks. RESULTS Ten patients underwent reimplantation of the pressurized nevus, and one patient dropped out. The recurrence of nevus at 52 weeks was not detected by pathological diagnosis in any patients. The L* value at 52 weeks was significantly higher than that of the target nevus. One patient received skin grafting due to contracture of the reconstructed skin. The epithelized area of the reconstructed skin, as the percentage of the original target nevus, was 55.5 ± 19.4 percent at 12 weeks and 85.0 ± 32.4 percent at 52 weeks. CONCLUSIONS The inactivated nevus caused inflammation and contracture for several months. However, no recurrence was observed, and combination therapy using an inactivated nevus with a cultured epidermal autograft may therefore be a novel treatment of giant congenital melanocytic nevi. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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21
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Ulmer A, Breuninger H, Kofler L, Häfner HM. Kongenitaler Riesennävus an Oberbauch und Brust in der Pubertät: Exzision mittels Expandertechnik. J Dtsch Dermatol Ges 2021; 19:930-933. [PMID: 34139071 DOI: 10.1111/ddg.14497_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Lukas Kofler
- Universitäts-Hautklinik Tübingen.,Zentrum für Seltene Hauterkrankungen/Kongenitale Nävi, Tübingen
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A Case of Giant Congenital Melanocytic Nevus Treated with Combination Therapy of Autologous Mesh-skin Grafts and Cultured Epithelial Autografts. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3613. [PMID: 34104617 PMCID: PMC8183747 DOI: 10.1097/gox.0000000000003613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022]
Abstract
Surgical excision of a giant congenital melanocytic nevus (GCMN) results in a full-thickness skin defect that is usually difficult to reconstruct even with tissue expansion or skin grafting. Here, we report the first case of GCMN treated with a combination of cultured epithelial autografts (CEAs) and mesh-skin grafts to reconstruct a large skin defect after surgical excision. A 14-month-old girl had a GCMN occupying 20% of the total body surface area of her neck and back. A 5-stage, full-thickness excision was performed between the age of 14 and 25 months. In each intervention, the wound after excision was covered with 1:6 mesh-skin grafts and CEAs, except for the neck, where patch skin grafts and CEAs were used. The skin grafts and CEAs were engrafted without shedding and epithelialization was completed within 3-4 weeks. Eighteen months after the last surgery, a mesh-like scar remained, with no recurrence or severe contracture observed. The cosmetic appearances of the donor sites (the scalp and lower abdomen) were acceptable. The application of CEAs with mesh-skin grafts has been established for the treatment of severe burns. This combined method also provides a possible option for the treatment of GCMNs.
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Lin W, Zhou Y, Li R. Giant Congenital Melanocytic Nevus in a Chinese Newborn. Clin Cosmet Investig Dermatol 2021; 14:557-559. [PMID: 34079321 PMCID: PMC8164964 DOI: 10.2147/ccid.s308725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022]
Abstract
Giant congenital melanocytic nevus (GCMN) is a rare birthmark disorder that reportedly affects 1 in 20,000-500,000 live births. Here, we present a case of GCMN in a 1-day-old newborn that covered the entire abdomen, reaching the thigh and chest, and laterally toward the backward aspect of the trunk to involve the entire back and buttocks. We discuss the diagnostic and treatment approach.
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Affiliation(s)
- Weizhao Lin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Yixuan Zhou
- The First Clinical Medical College of Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Ruiman Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China
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Ulmer A, Breuninger H, Kofler L, Häfner HM. Truncal giant congenital melanocytic nevus involving the breast in a girl reaching puberty: excision by expander technique. J Dtsch Dermatol Ges 2021; 19:930-933. [PMID: 33768728 DOI: 10.1111/ddg.14497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Lukas Kofler
- Universitäts-Hautklinik Tübingen.,Zentrum für Seltene Hauterkrankungen/Kongenitale Nävi, Tübingen
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Inactivated Nevus Tissue with High Hydrostatic Pressure Treatment Used as a Dermal Substitute after a 28-Day Cryopreservation Period. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3485189. [PMID: 33681354 PMCID: PMC7929648 DOI: 10.1155/2021/3485189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/18/2021] [Indexed: 11/17/2022]
Abstract
Background Giant congenital melanocytic nevi (GCMN) treatment remains controversial. While surgical resection is the best option for complete removal, skin shortage to reconstruct the skin defect remains an issue. We report a novel treatment using a high hydrostatic pressurization (HHP) technique and a cryopreservation procedure. However, cryopreservation may inhibit revascularization of implanted nevus tissue and cultured epidermal autograft (CEA) take. We aimed to investigate the influence of the cryopreservation procedure on the HHP-treated dermis specimen and CEA take on cryopreserved tissue. Methods Nevus tissue harvested from a patient with GCMN was inactivated with HHP of 200 MPa and then cryopreserved at -30°C for 28 days. The cryopreserved specimen was compared with fresh (HHP-treated without cryopreservation) tissue and with untreated (without HHP treatment) tissue to evaluate the extracellular matrix, basal membranes, and capillaries. Cultured epidermis (CE) take on the cryopreserved tissue was evaluated following implantation of the cryopreserved nevus tissue with CE into the subcutis of nude mice. Results No difference was observed between cryopreserved and fresh tissue in terms of collagen or elastic fibers, dermal capillaries, or basement membranes at the epidermal-dermal junction. In 4 of 6 samples (67%), applied CE took on the nevus tissues and regenerated the epidermis in the cryopreserved group compared with 5 of 6 samples (83%) in the fresh group. Conclusion Cryopreservation at -30°C for 28 days did not result in significant damage to inactivated nevus tissue, and applied CE on the cryopreserved nevus tissues took and regenerated the epidermis. Inactivated nevus tissue with HHP can be used as a dermal substitute after 28-day cryopreservation.
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Abstract
BACKGROUND Congenital melanocytic nevi (CMN) have a 1% to 5% lifetime risk for malignant transformation, with 50% of transformations occurring before the age of 5 years.The aim of this study is to assess the risk of melanoma development in pediatric patients with facial CMN involving the eyebrows, eyelid margins, and nasal alae where a margin of CMN was not excised to preserve these structures. METHODS A retrospective chart review of all pediatric patients with CMN from 1986 to 2014 was performed to review demographic information, diagnosis, and number of surgeries. Patients' clinical photographs were evaluated for residual nevi after completion of the treatment. RESULTS More than 950 medical charts of patients with CMN of the face area were reviewed. We identified 32 patients (13; 41% male) that met the study criteria with pathology-confirmed diagnosis of facial CMN with an average age of 4.4 years (3.3 months-15.8 years) at the time of initial surgery. The CMNs were classified into small (1; 3%), medium (14; 44%), large (14; 44%), and giant (3; 9%) based on their projected adult sizes. No patients developed melanoma within the small residual lesions left over the eyebrows and eyelids and inside nostrils at an average follow-up time of 5.6 (1.0-14.4) years and average age of 9.6 (1.8-19.2) years at the time of last follow-up. CONCLUSIONS Although a lifelong risk of malignant transformation of the residual CMN cannot be concluded, our results found no transformation in follow-up visits at an average age beyond the highest risk of melanoma development in childhood. We feel that leaving residual lesions on the face in areas of important anatomic structures for better cosmetic outcome is an acceptable risk.
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Abstract
PURPOSE OF REVIEW To update pediatric providers on new developments in our understanding of the clinical presentation, genetics, and systemic risks associated with congenital melanocytic nevi (CMN). RECENT FINDINGS CMN are primarily caused by sporadic postzygotic somatic mutations, most frequently in NRAS, and studies of the genetic underpinnings of CMN have demonstrated a diverse array of genetic drivers. The primary complications of large and giant CMN include neurocutaneous melanocytosis and malignant melanoma. Abnormalities in CNS MRI may predict a worse clinical course for patients and increased risk of melanoma. Targeted therapies of the MEK pathway have begun to be studied for the treatment of CMN and prevention of associated complications. SUMMARY Patients with large and giant CMN should be managed by an interdisciplinary care team for the monitoring of dermatologic, neurologic, and psychosocial concerns. Ongoing research is underway to better characterize the genetic drivers of CMN and to better guide development of targeted therapeutics.
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Topaz M, Gurevich M, Ashkenazi I. Simplified management of a giant forehead congenital nevus allows for early reconstruction. BMJ Case Rep 2020; 13:13/7/e234164. [PMID: 32665278 PMCID: PMC7359177 DOI: 10.1136/bcr-2019-234164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We report simplified surgical management of giant congenital forehead nevus that customarily requires the use of tissue expander for complete excision. Commencing treatment at the age of 3 months, the TopClosure tension relief system (TRS) was applied as an external tissue expander allowing preoperative skin stretching by mechanical creep. This was followed by partial excision of the nevus. Intraoperative stress-relaxation allowed further expansion of the skin. Postoperative wound closure was secured with the aid of the TRS. Repeated, six simple staged excisions of the forehead lesion and a minor skin graft to the eyelid part, allowed for delayed primary closure of the entire lesion by the age of 2. This simple alternative approach, which allows the early start and early conclusion of the reconstructive process, should be considered as the primary option in the treatment of these patients.
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Affiliation(s)
| | - Michael Gurevich
- Transplant Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Itamar Ashkenazi
- Surgery Department, Rambam Health Care Campus, Haifa, Haifa, Israel
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Fledderus A, Franke C, Eggen C, van Etten-Jamaludin F, van der Horst C, Brinkmann S, Spuls P. Outcomes and measurement instruments used in congenital melanocytic naevi research: A systematic review. J Plast Reconstr Aesthet Surg 2020; 73:703-715. [DOI: 10.1016/j.bjps.2019.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/21/2019] [Accepted: 11/22/2019] [Indexed: 11/28/2022]
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30
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Neuhaus K, Landolt M, Vojvodic M, Böttcher-Haberzeth S, Schiestl C, Meuli M, Masnari O. Surgical treatment of children and youth with congenital melanocytic nevi: self- and proxy-reported opinions. Pediatr Surg Int 2020; 36:501-512. [PMID: 32125501 DOI: 10.1007/s00383-020-04633-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The role of surgery in the management of congenital melanocytic nevi (CMN) is controversial. Data on surgical outcomes and predictors of satisfaction remain scarce. METHODS An online survey was employed following worldwide recruitment of youth aged 14-25 years (n = 44) and parents of children ≤ 18 years (n = 249) with CMN to query patterns of treatment and satisfaction with and opinions about the benefits of surgery. RESULTS In proxy-reports, 121 of 249 (49%) and in self-reports 30 of 44 (75%) participants underwent CMN excision. The most common reasons for surgery were psychosocial determinants, aesthetic improvement, and melanoma risk reduction. The overall satisfaction with surgical management was good, although no predictors for satisfaction could be identified. Higher current age of the child was found to predict decision regret in proxy-reports. Most participants indicated that having a scar is more socially acceptable than a CMN. Opinions differed on whether surgery should be deferred until the child is old enough to be involved in the decision-making process. CONCLUSIONS Whether and when to perform surgery in children with CMN is a multifaceted question. Awareness of common concerns as well as risks and benefits of surgery are essential to ensure critical reflection and balanced decision-making.
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Affiliation(s)
- Kathrin Neuhaus
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
| | - Markus Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Miliana Vojvodic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Sophie Böttcher-Haberzeth
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Clemens Schiestl
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Martin Meuli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Ornella Masnari
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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Wu M, Yu Q, Gao B, Sheng L, Li Q, Xie F. A large-scale collection of giant congenital melanocytic nevi: Clinical and histopathological characteristics. Exp Ther Med 2019; 19:313-318. [PMID: 31853305 DOI: 10.3892/etm.2019.8198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/03/2018] [Indexed: 11/06/2022] Open
Abstract
Giant congenital melanocytic nevi (GCMN) place a heavy psychological burden on patients due to their poor cosmetic appearance. The histopathological characteristics of GCMN have remained largely elusive. The present study investigated the histopathological characteristics of GCMN in association with their clinical appearance. A total of 98 patients diagnosed with GCMN were included in the present study and their clinical features were collected from their records. Lesion specimens were obtained and stained for histopathological analysis. Regarding the microscopic appearance of GCMN, nevi cells in the whole dermis exhibited different patterns than those in healthy tissues. Most GCMN cases featured a sub-epidermal non-involvement zone, which implies an early occurrence in embryo development. Darker nevi exhibited a higher density of infiltrated nevi cells and more pigment deposition; this appears to induce a poor skin texture. Chemical peeling and laser therapy only partly removes pigment particles and nevi cells in the upper portion of the dermis. The clinical features of GCMN are associated with the histopathological characteristics, and non-surgical therapy cannot remove the nevus cells in the deep dermis.
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Affiliation(s)
- Min Wu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, P.R. China
| | - Qingxiong Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, P.R. China
| | - Bowen Gao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, P.R. China
| | - Lingling Sheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, P.R. China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, P.R. China
| | - Feng Xie
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, P.R. China
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32
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Simple and efficient method for consecutive inactivation-cryopreservation of porcine skin grafts. J Artif Organs 2019; 23:147-155. [PMID: 31680190 DOI: 10.1007/s10047-019-01142-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
We previously reported that inactivation treatment by high hydrostatic pressurization (HHP) has potential utility as a novel skin regeneration therapy for various skin tumors. In this study, we evaluated whether glycerol-cryopreservation could be applied in order to preserve inactivated skin by HHP using a porcine model. Twenty full-thickness skin grafts (1.5 × 1.5 cm) were prepared from a minipig. The skin samples were inactivated by the HHP in normal saline or glycerol/fructose solution, followed by cryopreservation for 5 weeks at - 80 °C in each same solution. Another 10 grafts immediately after inactivation were prepared as non-cryopreserved controls. Nine grafts in each group were randomly implanted on the fascia of a host pig and removed at 1, 4 and 11 weeks after grafting. All grafts showed engraftment macroscopically. Hematoxylin eosin staining showed the cellular components in all areas of the dermis at 4 and 11 weeks after grafting, and immunohistochemical staining for CD31 showed the presence of capillaries in the grafts in all groups. The surface and cross-sectional areas of grafts in the normal saline solution cryopreserved group decreased between 1 and 11 weeks, whereas these areas in the glycerol cryopreserved group did not decrease significantly. Glycerol cryopreservation may therefore be a simple and efficient method for preserving porcine skin inactivated by HHP.
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Mosa A, Ho ES, Heinelt M, Wong K, Neuhaus K. Management of congenital melanocytic nevi in the plastic surgery clinic: Families' expectations and their persistent concern about malignancy. Pediatr Dermatol 2019; 36:876-881. [PMID: 31468600 DOI: 10.1111/pde.13987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Children with congenital melanocytic nevi (CMN) were historically managed with surgical removal to lower the risk of malignant transformation. The evolving literature over the last decade has indicated a significantly lower risk than previously estimated. Indications for excision currently revolve around aesthetic and psychosocial concerns. This study describes and evaluates the perspectives and expectations of patients and families referred to a pediatric plastic surgery clinic on CMN management. METHOD A two-part questionnaire was administered before and after an initial clinic appointment to evaluate patient and family concerns of lesion growth, risk of malignancy, treatment expectations, and stigmatization. RESULTS Thirty questionnaires were completed for 11 male and 19 female patients, mean age 9.2 years (1-25). Referring doctors (majority dermatologists) were rarely concerned about malignancy (8%), but parents listed it as a top reason for wanting the CMN removed (37%) and the most common expectation for the visit followed by information about surgical options and outcome. Before the clinic, 93% were at least "slightly" worried about CMN growth and 96% about malignancy, whereas 63% and 72%, respectively, after the clinic. CONCLUSIONS Families want information about surgical excision and are concerned about malignancy, indicating lingering misinformation or misconception about melanoma risk. For the majority, CMN removal remains at least slightly important, presumably for aesthetic reasons and remaining concern about malignancy. Involved health care professionals should assure reliable and coherent patient information about MM risk, indications for surgery and expected outcome to best support families' decision-making.
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Affiliation(s)
- Adam Mosa
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Emily S Ho
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Martina Heinelt
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karen Wong
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kathrin Neuhaus
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children's Hospital, Zurich, Switzerland
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Management of Congenital Melanocytic Nevus on Face Using Multiple Re-expansion Method: Aesthetic and Psychosocial Results. J Craniofac Surg 2019; 30:2385-2389. [PMID: 31609959 DOI: 10.1097/scs.0000000000006000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Congenital giant melanocytic nevus on the face is a challenging condition, especially in the pediatric population. It can produce significant cosmetic deformity with negative psychosocial effects in pediatric patients even after treatment. The objective of this study was to report aesthetic and psychosocial results in the management of congenital melanocytic nevus on the face using multiple reexpansion. METHODS Data of 6 patients with congenital melanocytic nevus on the face who underwent excision and multiple reexpansion at our center from September 2004 to August 2017, were retrospectively reviewed. To evaluate aesthetic outcomes, preoperative and final photographs of each patient were reviewed by 3 other plastic surgeons and 4 laypersons. For comparison, 6 other patients who were treated with conventional surgery during the same period were reviewed. After final reconstruction surgery, the authors surveyed patients' satisfaction via telephone. RESULTS Six patients were followed up for an average of 87.66 months (range, 55-123 months). The mean number of tissue expander insertions was 3.33 and the mean number of total expanders inserted was 4.83. Complication associated with expander exposure occurred in 1 patient during the fifth expansion. The average score of aesthetic outcome in the multiple reexpansion group was superior to that of the conventional group (2.60 versus 2.10, P = 0.03). During the telephone survey, patients did not rate their appearance as positive, although they were comparatively satisfied with the surgical procedure. CONCLUSION Considering the low rate of malignancy involving congenital melanocytic nevus in childhood, multiple reexpansion is an attractive option to obtain better results compared with other reconstructive methods.
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Ott H, Krengel S, Beck O, Böhler K, Böttcher-Haberzeth S, Cangir Ö, Fattouh M, Häberle B, Hüging M, Königs I, Kosch F, Rok K, Marathovouniotis N, Meyer L, Neuhaus K, Rothe K, Schiestl C, Sinnig M, Theiler M, von der Heydt S, Wälchli R, Weibel L, Wendenburg W, Breuninger H. Multidisziplinäre Langzeitbetreuung und zeitgemäße chirurgische Therapie kongenitaler melanozytärer Nävi – Empfehlungen des Netzwerks Nävuschirurgie. J Dtsch Dermatol Ges 2019; 17:1005-1017. [PMID: 31631552 DOI: 10.1111/ddg.13951_g] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/27/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Hagen Ott
- Pädiatrische Dermatologie und Allergologie, Epidermolysis bullosa-Zentrum, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Sven Krengel
- Dermatologische Gemeinschaftspraxis, Lübeck, Deutschland
| | - Otfrid Beck
- Abteilung Kinderchirurgie, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Deutschland
| | - Kornelia Böhler
- Klinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Sophie Böttcher-Haberzeth
- Zentrum Kinderhaut, Klinik für Plastische und Rekonstruktive Chirurgie, Universitätskinderspital Zürich, Zürich, Schweiz
| | - Özlem Cangir
- Abteilung für Kinderchirurgie, Zentrum für Vasculäre Malformationen (ZVM), Werner Forßmann-Klinik, Eberswalde, Deutschland
| | - Miriam Fattouh
- Sektion für Brandverletzungen, plastische und rekonstruktive Chirurgie, Abteilung für Kinderchirurgie, Altonaer Kinderkrankenhaus/Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Beate Häberle
- Kinderchirurgische Klinik und Poliklinik im Dr. v. Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland
| | - Martina Hüging
- Klinik und Poliklinik für Kinderchirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland
| | - Ingo Königs
- Sektion für Brandverletzungen, plastische und rekonstruktive Chirurgie, Abteilung für Kinderchirurgie, Altonaer Kinderkrankenhaus/Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Ferdinand Kosch
- Kinderchirurgische Klinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - Kralj Rok
- Zentrum Kinderhaut, Klinik für Plastische und Rekonstruktive Chirurgie, Universitätskinderspital Zürich, Zürich, Schweiz
| | - Nicos Marathovouniotis
- Klinik für Kinderchirurgie und Kinderurologie, Kinderkrankenhaus Amsterdamer Straße, Kliniken Köln, Köln, Deutschland
| | - Lutz Meyer
- Abteilung für Kinderchirurgie, Zentrum für Vasculäre Malformationen (ZVM), Werner Forßmann-Klinik, Eberswalde, Deutschland
| | - Kathrin Neuhaus
- Zentrum Kinderhaut, Klinik für Plastische und Rekonstruktive Chirurgie, Universitätskinderspital Zürich, Zürich, Schweiz
| | - Karin Rothe
- Klinik und Poliklinik für Kinderchirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland
| | - Clemens Schiestl
- Zentrum Kinderhaut, Klinik für Plastische und Rekonstruktive Chirurgie, Universitätskinderspital Zürich, Zürich, Schweiz
| | - Mechthild Sinnig
- Abteilung für Kinderchirurgie und -urologie, Kinderkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Martin Theiler
- Zentrum Kinderhaut, Abteilung Pädiatrische Dermatologie, Universitäts-Kinderspital Zürich und Dermatologische Klinik im Universitätsspital Zürich, Zürich, Schweiz
| | - Susanne von der Heydt
- Klinik und Poliklinik für Kinderchirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland
| | - Regula Wälchli
- Zentrum Kinderhaut, Abteilung Pädiatrische Dermatologie, Universitäts-Kinderspital Zürich und Dermatologische Klinik im Universitätsspital Zürich, Zürich, Schweiz
| | - Lisa Weibel
- Zentrum Kinderhaut, Abteilung Pädiatrische Dermatologie, Universitäts-Kinderspital Zürich und Dermatologische Klinik im Universitätsspital Zürich, Zürich, Schweiz
| | - Wera Wendenburg
- Klinik für Kinderchirurgie und Kinderurologie, Kinderkrankenhaus Amsterdamer Straße, Kliniken Köln, Köln, Deutschland
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36
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Ott H, Krengel S, Beck O, Böhler K, Böttcher‐Haberzeth S, Cangir Ö, Fattouh M, Häberle B, Hüging M, Königs I, Kosch F, Rok K, Marathovouniotis N, Meyer L, Neuhaus K, Rothe K, Schiestl C, Sinnig M, Theiler M, Heydt S, Wälchli R, Weibel L, Wendenburg W, Breuninger H. Multidisciplinary long‐term care and modern surgical treatment of congenital melanocytic nevi – recommendations by the CMN surgery network. J Dtsch Dermatol Ges 2019; 17:1005-1016. [DOI: 10.1111/ddg.13951] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/27/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Hagen Ott
- Department of Pediatric Dermatology and AllergologyCenter for Epidermolysis BullosaChildren's Hospital Auf der Bult Hanover Germany
| | | | - Otfrid Beck
- Division of Pediatric SurgeryCatholic Children's Hospital Wilhelmstift Hamburg Germany
| | - Kornelia Böhler
- Department of DermatologyVienna Medical University Vienna Austria
| | - Sophie Böttcher‐Haberzeth
- Center for Pediatric SkinDepartment of Plastic and Reconstructive SurgeryChildren's HospitalZurich University Medical Center Zurich Switzerland
| | - Özlem Cangir
- Department of Pediatric SurgeryCenter for Vascular MalformationsWerner Forßmann Hospital Eberswalde Germany
| | - Miriam Fattouh
- Division of Burn Injuries, Plastic and Reconstructive SurgeryDepartment of Pediatric SurgeryChildren's Hospital Altona/University Medical Center Eppendorf Hamburg Germany
| | - Beate Häberle
- Department of Pediatric SurgeryDr. v. Hauner Children's HospitalLudwig Maximilian University Munich Germany
| | - Martina Hüging
- Department of Pediatric SurgeryCharité University Medicine, Virchow Medical Center Berlin Germany
| | - Ingo Königs
- Division of Burn Injuries, Plastic and Reconstructive SurgeryDepartment of Pediatric SurgeryChildren's Hospital Altona/University Medical Center Eppendorf Hamburg Germany
| | - Ferdinand Kosch
- Department of Pediatric SurgeryKarlsruhe Medical Center Karlsruhe Germany
| | - Kralj Rok
- Center for Pediatric SkinDepartment of Plastic and Reconstructive SurgeryChildren's HospitalZurich University Medical Center Zurich Switzerland
| | - Nicos Marathovouniotis
- Department of Pediatric Surgery and Pediatric UrologyChildren's Hospital Amsterdamer Straße Cologne Germany
| | - Lutz Meyer
- Department of Pediatric SurgeryCenter for Vascular MalformationsWerner Forßmann Hospital Eberswalde Germany
| | - Kathrin Neuhaus
- Center for Pediatric SkinDepartment of Plastic and Reconstructive SurgeryChildren's HospitalZurich University Medical Center Zurich Switzerland
| | - Karin Rothe
- Department of Pediatric SurgeryCharité University Medicine, Virchow Medical Center Berlin Germany
| | - Clemens Schiestl
- Center for Pediatric SkinDepartment of Plastic and Reconstructive SurgeryChildren's HospitalZurich University Medical Center Zurich Switzerland
| | - Mechthild Sinnig
- Department of Pediatric Surgery and Pediatric UrologyChildren's Hospital Auf der Bult Hanover Germany
| | - Martin Theiler
- Center for Pediatric SkinDivision of Pediatric DermatologyZurich University Children's Hospital, and Department of Dermatology, Zurich University Medical Center Zurich Switzerland
| | - Susanne Heydt
- Department of Pediatric SurgeryCharité University Medicine, Virchow Medical Center Berlin Germany
| | - Regula Wälchli
- Center for Pediatric SkinDivision of Pediatric DermatologyZurich University Children's Hospital, and Department of Dermatology, Zurich University Medical Center Zurich Switzerland
| | - Lisa Weibel
- Center for Pediatric SkinDivision of Pediatric DermatologyZurich University Children's Hospital, and Department of Dermatology, Zurich University Medical Center Zurich Switzerland
| | - Wera Wendenburg
- Department of Pediatric Surgery and Pediatric UrologyChildren's Hospital Amsterdamer Straße Cologne Germany
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Breuninger H, Häfner H. Serial excision with power stretching for large and giant melanocytic nevi of the trunk. J Dtsch Dermatol Ges 2019; 17:852-855. [DOI: 10.1111/ddg.13903] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Helmut Breuninger
- Department of DermatologyTübingen University Medical Center Tübingen Germany
| | - Hans‐Martin Häfner
- Department of DermatologyTübingen University Medical Center Tübingen Germany
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Breuninger H, Häfner H. Powerdehnung bei der seriellen Exzision großer und riesiger melanozytärer Nävi am Rumpf. J Dtsch Dermatol Ges 2019; 17:852-855. [DOI: 10.1111/ddg.13903_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Passeron T, Genedy R, Salah L, Fusade T, Kositratna G, Laubach H, Marini L, Badawi A. Laser treatment of hyperpigmented lesions: position statement of the European Society of Laser in Dermatology. J Eur Acad Dermatol Venereol 2019; 33:987-1005. [DOI: 10.1111/jdv.15497] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/14/2019] [Indexed: 12/16/2022]
Affiliation(s)
- T. Passeron
- Department of Dermatology Centre Hospitalier Universitaire Nice Université Côté d'Azur Nice France
- INSERM U1065, Team 12, C3M Université Côté d'Azur Nice France
| | - R. Genedy
- Faculty of Medicine Department of Dermatology Alexandria University Alexandria Egypt
| | - L. Salah
- Ministry of Health Jeddah Saudi Arabia
| | | | - G. Kositratna
- Department of Dermatology Massachusetts General Hospital Harvard Medical School Boston MA USA
| | - H.‐J. Laubach
- Department of Dermatology Hôpitaux Universitaires de Genève Geneva Switzerland
| | - L. Marini
- The Skin Doctors Center Trieste Italy
| | - A. Badawi
- National Institute of Laser Enhanced Sciences Cairo University Giza Egypt
- Department of Dermatology Faculty of Medicine University of Szeged Szeged Hungary
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Chistyakova GN, Grishkina AA, Kayumova AV, Giniyatova AA, Remizova II, Barlit OG, Filatova AS. [Congenital giant melanocytic nevi]. Arkh Patol 2019; 81:89-91. [PMID: 31626210 DOI: 10.17116/patol20198105189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The paper describes a case of a rare tumor disease with massive involvement of the skin, mainly that of the occipital head and brain and liver tissues in a newborn infant. It considers the morphological and immunohistochemical characteristics of a giant tumor cell nidus in the skin of the occipital head.
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Affiliation(s)
- G N Chistyakova
- Urals Research Institute for Maternal and Child Care, Ministry of Health of Russia, Yekaterinburg, Russia
| | - A A Grishkina
- Urals Research Institute for Maternal and Child Care, Ministry of Health of Russia, Yekaterinburg, Russia
| | - A V Kayumova
- Urals Research Institute for Maternal and Child Care, Ministry of Health of Russia, Yekaterinburg, Russia
| | - A A Giniyatova
- Urals Research Institute for Maternal and Child Care, Ministry of Health of Russia, Yekaterinburg, Russia
| | - I I Remizova
- Urals Research Institute for Maternal and Child Care, Ministry of Health of Russia, Yekaterinburg, Russia
| | - O G Barlit
- Urals Research Institute for Maternal and Child Care, Ministry of Health of Russia, Yekaterinburg, Russia
| | - A S Filatova
- Urals Research Institute for Maternal and Child Care, Ministry of Health of Russia, Yekaterinburg, Russia
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41
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Lemaître S, Gardrat S, Vincent-Salomon A, Galatoire O, Lévy-Gabriel C, Desjardins L. Malignant Transformation of a Multi-Operated Divided Nevus of the Eyelids. Ocul Oncol Pathol 2018; 4:112-115. [PMID: 30320091 DOI: 10.1159/000479069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/23/2017] [Indexed: 11/19/2022] Open
Abstract
A woman in her early fifties had regular follow-up for a medium-sized divided nevus of the eyelids which had undergone several surgical excisions during childhood for functional and esthetic reasons. Malignant transformation of the nevus occurred in the inferior eyelid, with the appearance of a new pigmented flat lesion. Histology showed in situ melanoma, and an NRAS activating mutation was found. A full-thickness excision of the inferior eyelid was performed, followed by reconstruction. Local recurrence of the melanoma occurred 1 year after surgery. Lifelong follow-up of divided nevi of the eyelids is recommended, even if very few cases of malignant transformation have been reported so far.
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Affiliation(s)
- Stéphanie Lemaître
- Institut Curie, Institut Curie, Paris, France.,Université Paris Descartes, Institut Curie, Paris, France.,Ocular Oncology, Institut Curie, Paris, France
| | - Sophie Gardrat
- Institut Curie, Institut Curie, Paris, France.,Pathology and Tumor Biology, Institut Curie, Paris, France
| | - Anne Vincent-Salomon
- Institut Curie, Institut Curie, Paris, France.,Pathology and Tumor Biology, Institut Curie, Paris, France
| | | | - Christine Lévy-Gabriel
- Institut Curie, Institut Curie, Paris, France.,Ocular Oncology, Institut Curie, Paris, France
| | - Laurence Desjardins
- Institut Curie, Institut Curie, Paris, France.,Ocular Oncology, Institut Curie, Paris, France
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Eggen C, Lommerts J, van Zuuren E, Limpens J, Pasmans S, Wolkerstorfer A. Laser treatment of congenital melanocytic naevi: a systematic review. Br J Dermatol 2018; 178:369-383. [DOI: 10.1111/bjd.16094] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
- C.A.M. Eggen
- Department of Dermatology; Erasmus University Medical Centre Rotterdam; Rotterdam the Netherlands
| | - J.E. Lommerts
- Netherlands Institute for Pigment Disorders; Department of Dermatology; University of Amsterdam; the Netherlands
| | - E.J. van Zuuren
- Department of Dermatology; Leiden University Medical Centre; Leiden the Netherlands
| | - J. Limpens
- Medical Library; Research Support; Academic Medical Centre; University of Amsterdam; The Netherlands
| | - S.G.M.A. Pasmans
- Department of Dermatology; Erasmus University Medical Centre Rotterdam; Rotterdam the Netherlands
| | - A. Wolkerstorfer
- Netherlands Institute for Pigment Disorders; Department of Dermatology; University of Amsterdam; the Netherlands
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43
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Häfner HM, Breuninger H. Serial excision with power-stretching of the skin in giant melanocytic nevi therapy. J Plast Reconstr Aesthet Surg 2017; 71:443-445. [PMID: 29242149 DOI: 10.1016/j.bjps.2017.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 10/06/2017] [Accepted: 11/09/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Hans-Martin Häfner
- Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, D-72076 Tübingen, Germany
| | - Helmut Breuninger
- Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, D-72076 Tübingen, Germany.
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Morimoto N, Kakudo N, Kako A, Nishimura K, Mitsui T, Miyake R, Kuro A, Hihara M, Kusumoto K. A case report of the first application of culture epithelial autograft (JACE ®) for giant congenital melanocytic nevus after its approval in Japan. J Artif Organs 2017; 21:261-264. [PMID: 29147946 DOI: 10.1007/s10047-017-1007-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
In Japan, the JACE® cultured epidermal autograft (CEA) was approved and covered by public healthcare insurance for use in the treatment of giant congenital melanocytic nevus (GCMN) in 2016. We herein report the results of the application of JACE® after curettage and Q-switched ruby laser therapy. The current patient was the first patient with GCMN to be treated with JACE® since its approval. A 3-month-old girl had a hairy GCMN of 9.5 cm in diameter from her cheek to her temple on the left side of her face. We first performed curettage of the nevus on the temple and applied irradiation using a Q-switched ruby laser; however, erosion relapsed at 2 months after first surgery. After preparing JACE®, we performed curettage a second time at 7 months with irradiation of a Q-switched ruby laser and the application of the CEA. The CEA took successfully and the wound was completely epithelized at 1 week after grafting. Re-pigmentation is an important issue that remains to be solved; however, overcoming this would allow for a deeper abrasion or more intense laser irradiation to be performed in cases in which CEA will be subsequently applied.
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Affiliation(s)
- Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, 573-1010, Japan.
| | - Natsuko Kakudo
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, 573-1010, Japan
| | - Ayako Kako
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, 573-1010, Japan
| | - Keiko Nishimura
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, 573-1010, Japan
| | - Toshihito Mitsui
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, 573-1010, Japan
| | - Ryohei Miyake
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, 573-1010, Japan
| | - Atsuyuki Kuro
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, 573-1010, Japan
| | - Masakatsu Hihara
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, 573-1010, Japan
| | - Kenji Kusumoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, 573-1010, Japan
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Sakamoto M, Morimoto N, Jinno C, Mahara A, Ogino S, Suzuki S, Kusumoto K, Yamaoka T. Melanin pigments in the melanocytic nevus regress spontaneously after inactivation by high hydrostatic pressure. PLoS One 2017; 12:e0186958. [PMID: 29091921 PMCID: PMC5665530 DOI: 10.1371/journal.pone.0186958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/10/2017] [Indexed: 11/20/2022] Open
Abstract
We report a novel treatment for giant congenital melanocytic nevi (GCMN) that involves the reuse of resected nevus tissue after high hydrostatic pressurization (HHP). However, the remaining melanin pigments in the inactivated nevus tissue pose a problem; therefore, we performed a long-term observation of the color change of inactivated nevus tissue after HHP. Pressurized nevus specimens (200 MPa group, n = 9) and non-pressurized nevus tissues (control group, n = 9) were subcutaneously implanted into nude mice (BALB/c-nu) and then harvested 3, 6, and 12 months later. Color changes of the nevus specimens were evaluated. In the 200 MPa group, the specimen color gradually regressed and turned white, and brightness values were significantly higher in the 200 MPa group than in the control group after 6 months. This indicated that melanin pigments in the pressurized nevus tissue had spontaneously degraded and regressed. Therefore, it is not necessary to remove melanin pigments in HHP-treated nevus tissue.
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Affiliation(s)
- Michiharu Sakamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Osaka, Japan
- * E-mail:
| | - Chizuru Jinno
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Atsushi Mahara
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
| | - Shuichi Ogino
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigehiko Suzuki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Kusumoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tetsuji Yamaoka
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
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Heister M, Häfner H, Breuninger H, Schulz C, Meier K, Kofler L, Spott C, Röcken M, Schnabl S, Eberle F. Tumescent local anaesthesia for early dermatosurgery in infants. J Eur Acad Dermatol Venereol 2017; 31:2077-2082. [DOI: 10.1111/jdv.14461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/20/2017] [Indexed: 01/02/2023]
Affiliation(s)
- M. Heister
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - H.M. Häfner
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - H. Breuninger
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - C. Schulz
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - K. Meier
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - L. Kofler
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - C. Spott
- Operational Controlling and Reporting; Eberhard Karls University; Tübingen Germany
| | - M. Röcken
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - S.M. Schnabl
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - F.C. Eberle
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
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47
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Expanded bi-pedicled “sleeve” flap for reconstruction of the upper extremity after large circumferential nevus excision in children. J Plast Reconstr Aesthet Surg 2016; 69:1676-1682. [DOI: 10.1016/j.bjps.2016.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/31/2016] [Indexed: 11/23/2022]
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48
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Morimoto N, Mahara A, Jinno C, Ogawa M, Kakudo N, Suzuki S, Fujisato T, Kusumoto K, Yamaoka T. The superiority of the autografts inactivated by high hydrostatic pressure to decellularized allografts in a porcine model. J Biomed Mater Res B Appl Biomater 2016; 105:2653-2661. [DOI: 10.1002/jbm.b.33807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/25/2016] [Accepted: 10/12/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Naoki Morimoto
- Department of Plastic and Reconstructive Surgery; Kansai Medical University; Hirakata City Osaka Japan
| | - Atsushi Mahara
- Department of Biomedical Engineering; National Cerebral and Cardiovascular Center Research Institute; Suita City Osaka Japan
| | - Chizuru Jinno
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine; Kyoto University; Kyoto City Kyoto Japan
| | - Mami Ogawa
- Department of Biomedical Engineering; Osaka Institute of Technology; Osaka City Osaka Japan
| | - Natsuko Kakudo
- Department of Plastic and Reconstructive Surgery; Kansai Medical University; Hirakata City Osaka Japan
| | - Shigehiko Suzuki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine; Kyoto University; Kyoto City Kyoto Japan
| | - Toshia Fujisato
- Department of Biomedical Engineering; Osaka Institute of Technology; Osaka City Osaka Japan
| | - Kenji Kusumoto
- Department of Plastic and Reconstructive Surgery; Kansai Medical University; Hirakata City Osaka Japan
| | - Tetsuji Yamaoka
- Department of Biomedical Engineering; National Cerebral and Cardiovascular Center Research Institute; Suita City Osaka Japan
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49
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The Alteration of the Epidermal Basement Membrane Complex of Human Nevus Tissue and Keratinocyte Attachment after High Hydrostatic Pressurization. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1320909. [PMID: 27747221 PMCID: PMC5056241 DOI: 10.1155/2016/1320909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 11/23/2022]
Abstract
We previously reported that human nevus tissue was inactivated after high hydrostatic pressure (HHP) higher than 200 MPa and that human cultured epidermis (hCE) engrafted on the pressurized nevus at 200 MPa but not at 1000 MPa. In this study, we explore the changes to the epidermal basement membrane in detail and elucidate the cause of the difference in hCE engraftment. Nevus specimens of 8 mm in diameter were divided into five groups (control and 100, 200, 500, and 1000 MPa). Immediately after HHP, immunohistochemical staining was performed to detect the presence of laminin-332 and type VII collagen, and the specimens were observed by transmission electron microscopy (TEM). hCE was placed on the pressurized nevus specimens in the 200, 500, and 1000 MPa groups and implanted into the subcutis of nude mice; the specimens were harvested at 14 days after implantation. Then, human keratinocytes were seeded on the pressurized nevus and the attachment was evaluated. The immunohistochemical staining results revealed that the control and 100 MPa, 200 MPa, and 500 MPa groups were positive for type VII collagen and laminin-332 immediately after HHP. TEM showed that, in all of the groups, the lamina densa existed; however, anchoring fibrils were not clearly observed in the 500 or 1000 MPa groups. Although the hCE took in the 200 and 500 MPa groups, keratinocyte attachment was only confirmed in the 200 MPa group. This result indicates that HHP at 200 MPa is preferable for inactivating nevus tissue to allow its reuse for skin reconstruction in the clinical setting.
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Morimoto N, Jinno C, Sakamoto M, Kakudo N, Yamaoka T, Kusumoto K. An Exploratory Clinical Trial of a Novel Treatment for Giant Congenital Melanocytic Nevi Combining Inactivated Autologous Nevus Tissue by High Hydrostatic Pressure and a Cultured Epidermal Autograft: Study Protocol. JMIR Res Protoc 2016; 5:e162. [PMID: 27515295 PMCID: PMC4999532 DOI: 10.2196/resprot.6195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/14/2016] [Accepted: 07/20/2016] [Indexed: 12/13/2022] Open
Abstract
Background Giant congenital melanocytic nevi (GCMNs) are large brown to black skin lesions that appear at birth and are associated with a risk of malignant transformation. It is often difficult to reconstruct large full-thickness skin defects after the removal of GCMNs. Objective To overcome this difficulty we developed a novel treatment to inactivate nevus tissue and reconstruct the skin defect using the nevus tissue itself. For this research, we designed an exploratory clinical study to investigate the safety and efficacy of a novel treatment combining the engraftment of autologous nevus tissue inactivated by high hydrostatic pressurization with a cultured epidermal autograft (CEA). Methods Patients with congenital melanocytic nevi that were not expected to be closed by primary closure will be recruited for the present study. The target number of nevi is 10. The full-thickness nevus of the target is removed and pressurized at 200 MPa for 10 minutes. The pressurized and inactivated nevus is sutured to the original site. A small section of the patient’s normal skin is taken from around the nevus region and a CEA is prepared after a 3-week culturing process. The CEA is then grafted onto the engrafted inactivated nevus at four weeks after its retransplantation. The primary endpoint is the engraftment of the CEA at 8 weeks after its transplantation and is defined as being engrafted when the engraftment area of the inactivated nevus is 60% or more of the pretransplantation nevus area and when 80% or more of the transplanted inactivated nevus is epithelialized. Results The study protocol was approved by the Institutional Review Board of Kansai Medical University (No. 1520-2, January 5, 2016: version 1.3). The study opened for recruitment in February 2016. Conclusions This protocol is designed to show feasibility in delivering a novel treatment combining the engraftment of inactivated autologous nevus tissue and CEA. This is the first-in-man clinical trial of this treatment, and it should be a promising treatment of patients suffering from GCMN. Trial Registration University Hospital Medical Information Network: UMIN000020732; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000022198 (Archived by WebCite at http://www.webcitation.org/6jLZH2vDN)
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Affiliation(s)
- Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan.
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