Staged Mosaic Punching Excision of a Kissing Nevus on the Eyelid

A congenital divided nevus, also known as kissing nevus, is a type of congenital compound nevus that affects equal areas of the upper and lower eyelids. The edges of the nevus touch or "kiss" during closure of the lids, owing to its extension to the lid margins. Multiple treatment modalities, such as dermabrasion, cryotherapy, primary closure after excision, and skin grafts, have been proposed; however, complications such as recurrence, ectropion, skin color mismatch, and scar contractures are known to occur. This study aimed to introduce a staged excision using the 10,600-nm CO₂ pulsed laser to remove a congenital divided nevus without noticeable complications.

From August 2015 to December 2018, patients with congenital divided nevus underwent staged laser excision. Seven patients underwent staged mosaic pattern punch excision with a laser. Eight patients underwent concomitant excision, and one patient underwent skin grafting of the medial canthus. Patient satisfaction was assessed immediately and at 3 months after the procedure.

During the study period, 15 patients (10 women and 5 men), with a mean age of 26.0 years (range 13-73 years), underwent laser excision. Continuity of the eyelid margins was maintained in 13 patients. In one patient, the eyelashes grew inward and developed inflammation. No patient developed complications during the healing process, except for partial loss of cilia. Eleven patients were very satisfied, whereas three were satisfied with the results. One patient discontinued treatment after two laser sessions.

We performed multiple staged mosaic punching excisions of a congenital divided nevus with the CO₂ laser in 15 cases. We observed consistent therapeutic results without definite recurrence, while maintaining the continuity of the eyelid and eyelash.

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