Cosmetically Challenging Congenital Melanocytic Nevi

Area of Science:

• Dermatology
• Pediatric Surgery
• Oncology

Background:

• Congenital melanocytic nevi (CMN) carry a 1-5% lifetime risk of malignant transformation, with half occurring before age 5.
• Facial CMN involving critical structures like eyebrows, eyelids, and nostrils pose a surgical challenge.
• Preserving these structures may necessitate leaving residual nevus margins.

Purpose of the Study:

• To evaluate the risk of melanoma developing in pediatric patients with facial CMN.
• To assess the safety of preserving facial CMN margins involving eyebrows, eyelid margins, and nasal alae.
• To determine if cosmetic preservation impacts melanoma risk in children.

Main Methods:

• Retrospective chart review of pediatric patients with facial CMN (1986-2014).
• Analysis of demographic data, diagnoses, and surgical history.
• Evaluation of clinical photographs for residual nevi and clinical outcomes.

Main Results:

• Over 950 charts reviewed; 32 pediatric patients met criteria for facial CMN.
• No melanoma developed in residual CMN on eyebrows, eyelids, or nostrils after an average follow-up of 5.6 years.
• Average patient age at initial surgery was 4.4 years, with last follow-up at 9.6 years.

Conclusions:

• Leaving residual facial CMN for cosmetic reasons in pediatric patients showed no melanoma transformation during follow-up.
• The observed outcomes suggest that preserving facial CMN in critical areas is an acceptable risk.
• While lifelong risk cannot be excluded, the findings support cosmetic preservation beyond the peak childhood melanoma risk period.