Mia A. Mologousis et al.
The nevi melanocytic congenital (CMN) are certainly benign lesions but they carry an increased risk of melanoma, which varies according to their size, and they can be easily cause cosmetic discomfort. There is currently no consensus on treatment recommendations.
Clinical monitoring is the shared standard, but many health care providers are inclined to their removal in order to prevent possible psychosocial repercussions or to reduce oncological risk.
This paper presents an update on strategies management of these injuries.
NMCs evolve with age and change color, thickness, and size. However, the appearance of pain, ulceration, bleeding, and disproportionate growth relative to the patient may be indications for biopsy.
The raccommendations of a group of expert pediatric dermatologists from the United States indicate for nevi melanocytic congenital giant nevi (GCMNs) the desirability of a visit every three months in the first year of life and every year thereafter. For the CMN of medium and small size, which attach a lower and current risk of melanoma in adulthood the frequency of monitoringmay be less.
NCM is the rare proliferation of melanocytes within the central nervous system (CNS) in patients with NMC . It occurs in 7-23% of patients with large lesions (GCMN o CMNmultiple medium. Neale and colleagues have noted how quantity isa stronger predictor of NCM thanlesion size [Neale, H et al. J Am Acad Dermatol 2022]. NCM can develop neurological symptoms such as seizures, delay developmental, associated diseases such as syringomyelia or brain tumors.
Although there is a lack of consensus on specific recommendations, thescreening may be considered for infants with CMN medium-sized multiples, and for any GCMN. Early screening by magnetic resonance imaging of the brain and of the spine for avoid the use of the medium of contrast (necessaryo to visualize melanin after myelination which intervenes around 6 months of life).
The management of nevi melanocytic congenital ranges from clinical monitoring to extensive excision. New data indicate that the risk of melanoma is relatively lower than previously reported (the melanoma occurs in about 1 percent of all patients with CMN and in 2% depatients with GCMN. Any treatments are aimed primarily at cosmetic improvement, as recommended by the CMN Surgery Network. Careful discussion with families/ is deemed necessary to determine individual treatment goals, weighing the risks and benefits of the intervention.
It has not been confirmed in the literature that CMN removal reduces the risk of melanoma. Cases of melanoma arising in NMC patients undergoing extensive treatment have been reported. Up to one third ofome melanomas arising in patients with CMNs is associated with the central nervous system and removal of the skin lesion does not affect this risk at all.
Concerns about possible psycho-social represent the main motivation of those urging their removal. CMNs have often been associated with lower self-esteem and frequent stigmatization; this is particularly true for large ones
And for those located in aesthetically sensitive areas such as the face. While it should be considered that up to 65% of congenital nevi may clear spontaneously, although not completely, it should be kept in mind that delaying treatment may complicate less quality outcomes. removal or worsen aesthetics.
When treat ? It should be considered that it is preferable to intervene before 3 - 4 years of age to spare the child the memory of the procedure and recovery and to achieve the best possible cosmetic result.
Anesthesiologic risks. Chere are often concerns, especially when it comes to multiple sessions multiple, about the effects of general anesthesia on neurodevelopment.
Lesion size. Small and medium-sized nevi are naturally more likely to be candidates for treatment, preferably surgical. Nevi giants can be treated with destructive surface techniques (laser, curettage neonatal, dermabrasion) with highly variable outcomes, incomplete removal, and with risk of scar sequelae in the case of curettage and dermabrasion.
Regular bathing with oil cleansers and frequent use of emollients are recommended For the
persistently red and/or itchy skin, topical corticosteroids and inhibitors calcineurin
offer a preferred solution but require multiple treatments and sometimes expensive. The laser can cause changes dermoscopic and histologic changes. It is not considered likely that pilar removal techniques can produce melanoma.
Surgical excision is the most widely used method for the removal of small and medium-sized nevi for which a single surgical time is required. In contrast, giant nevi or large ones may require serial excisions, tissue expansion, flaps and/or grafts for satisfactory closure, which may result in more visible and extensive scarring. Cheng and colleagues demonstrated that serial excision required more proceduresbut shorter operative times and hospital stays than tissue expansion and skin grafting [Cheng, X et al, JCosmet Dermatol, 2022]. The graft offered nonquality aesthetic results, and expanders have led a further complications. In general, the families riting a good percentage that surgery is necessary, to be performed as soon as possible.