Cultured epithelial autografts for the treatment of large-to-giant congenital melanocytic nevus in 31 patients

Abstract

Introduction Giant congenital melanocytic nevus (GCMN) is a large melanocytic nevus, and its full-thickness removal is usually difficult due to the lack of skin available for reconstruction. Curettage is an alternative approach in cases of GCMN to remove the superficial dermis above the cleavage plane with a curette in the neonatal period, and its major complications include repigmentation, retarded epithelization, and hypertrophic scar formation. In Japan, the JACE® cultured epidermal autograft (CEA) was approved and covered by public healthcare insurance for the treatment of congenital melanocytic nevus (CMN) that is difficult to treat with conventional methods in 2016. We have used CEA for wounds after curettage in the neonatal period or following ablation after the neonatal period in combination with laser therapies to reduce the above-mentioned complications. Methods In this study, we summarized all consecutive CMN patients treated using CEA from December 2016 to April 2019 and evaluated the duration required for epithelialization, incidence of hypertrophic scar, and color change in the target nevus by comparing the L∗ values one year later between the Curettage group, the non-Curettage group with initial treatment or the subsequent group. Results No significant differences were seen in the epithelization period or incidence of hypertrophic scars among the groups, but the color of the target nevus was improved significantly in the Curettage group (p < 0.01) and non-Curettage group with initial treatment (p < 0.01). Conclusions In conclusion, CEA seems to accelerate epithelization after curettage or ablation of CMN, and this treatment could improve the color of CMN when applied initially.

Incidence of neurocutaneous melanosis in Japanese pediatric patients with congenital melanocytic nevi

“…Whether all patients with CMN should undergo brain MRI remains an open question. A positive result on MRI for NCM may impact decisions regarding timing and extent of surgical management for CMN, because brain MRI can suggest whether NCM is stable or progressive and indications for aggressive treatment of CMN will be considered based on the prognosis of NCM 31 . Patients with NCM may be asymptomatic, but occasionally present with headache associated with hydrocephalus, seizure, mental retardation, and various abnormalities of the CNS, including Dandy–Walker syndrome, Chiari malformation, syringomyelia, and lissencephaly 7 , 15 , 32 .…”

Clinical Indications of Cultured Epithelial Autografts

“…This study also reported a mean take rate of 68% for CEA, while STSG had a take rate of 84%. 46 In a 2021 study by Morimoto et al, 48 31 patients with GCMN were treated with CEA after curettage of the lesions. Cultured epithelial autograft significantly affected the speed and efficiency of wound healing, when compared with patients who did not receive CEA after curettage, demonstrating that CEAs can accelerate epithelialization in such wounds.…”

A clinical and biologic review of congenital melanocytic nevi

“…Clinical studies showed that CEA could be an effective option to accelerate epithelization after curettage or ablation of CMN. 74,76,77 However, the low take rate compared with conventional grafting techniques and the vulnerability of skin produced from CEA cannot be ignored. Moreover, the high financial cost and the demand for nursing resources have limited the wide applicability of CEA.…”

“…In theory, CEA can provide one‐stage wound coverage, thereby reducing the number of surgeries. Clinical studies showed that CEA could be an effective option to accelerate epithelization after curettage or ablation of CMN 74,76,77 . However, the low take rate compared with conventional grafting techniques and the vulnerability of skin produced from CEA cannot be ignored.…”