Comparison of three different surgical approaches for the treatment of large/giant congenital melanocytic nevus

Abstract

Objective Treating large/giant congenital melanocytic nevus (L/GCMN) is challenging for surgeons. Operative approaches commonly used to remove L/GCMN include serial excision, tissue expansion, and skin grafting. Thus, we retrospectively compared these three operations' applications and therapeutic effects. Methods The clinical data of 97 L/GCMN patients from June 1, 2015, to June 1, 2019, were collected and divided into three groups according to the operations used: serial excision group (SE group, n = 18), tissue expansion group (TE group, n = 23), and skin grafting group (SG group, n = 56). The location and size of the lesion, the number of operations, duration of each operation, preoperative preparation time, postoperative hospital stay, complications, and clinical outcomes of all patients were collected and assessed. Results The SE group had the most times of operation (3.9 and 6.0 for LCMN and GCMN, respectively), the shortest surgery length (56.3 min), and the shortest postoperative hospital stay (10.0d). The SE and SG groups required much less time to prepare for surgery and had a lower rate of complications than the TE group. During the 11.9‐month median follow‐up period, the SE and TE groups had better postoperative outcomes than the SG group. Conclusion Each of the three operations has different advantages and disadvantages, and the specific surgical strategy should be decided based on the patient's unique circumstances.

Updates in the Management of Congenital Melanocytic Nevi

“…Each approach has its own challenges, especially in the management of large to giant CMN. Cheng and colleagues demonstrated that serial excision required more procedures but shorter operative times and hospital stays versus tissue expansion and skin grafting [64]. Grafting offered the least desirable cosmesis.…”

A clinical and biologic review of congenital melanocytic nevi

“…In summary, each of the three methods has respective benefits and drawbacks, thus the specific surgical strategy should be determined in light of the patient's particular circumstances. 71 For patients with GCMN, the complete excision of giant nevi is impractical in many cases due to the lack of skin for reconstruction.…”

“…In a retrospective study, the applicability and therapeutic outcomes were compared in patients with LCMN 71 . The authors found that the surgery length and hospital stay in the serial excision group were the shortest, while the times of operation were the highest.…”

“…The unsatisfactory outcomes might be caused by the large scars and varied colors in the lesion area and the considerable injury in the donor area, which failed to meet aesthetic requirements. In summary, each of the three methods has respective benefits and drawbacks, thus the specific surgical strategy should be determined in light of the patient's particular circumstances 71 …”