[Treatment of large congenital pigmented nevi]

Large congenital nevi present a difficult therapeutic problem, since the surgeon must seek to achieve two objectives: To minimize the risk of malignancy; To obtain an acceptable cosmetic result. The first objective calls for early and radical excision of all pigmented areas; this may be impossible because of the operative risk, and the risk of leaving the patient with a deformity or disfiguring scars. The cosmetic indication may justify less aggressive surgery. Relatively new experience indicates that removal of the superficial layers of the nevus shortly after birth is followed by healing with non-pigmented or much less pigmented skin. By combining the removal of the superficial layers of skin with full-thickness resections and reconstructive plastic surgery, it is possible in most cases to achieve a favourable cosmetic result and, at the same time, reduce risk of early malignancy. Wherever possible, the surgical treatment should be completed before the age of five or six years in order to prevent long-lasting psychologic and social effects of the nevus deformity.