Excision of the large congenital melanocytic nevus facilitated by the use of the tissue expander

Abstract

Large congenital melanocytic nevi both present a cosmetic problem and may predispose to the development of a melanoma. We present a series of three patients in whom the tissue expander was employed to facilitate a large excision with primary closure and excellent cosmesis.

Radical Resection of Giant Congenital Melanocytic Nevus and Reconstruction With Meek-Graft Covered Integra Dermal Template

“…If more than three procedures are required to complete the resection, the former options should be considered. Tissue expansion is recommended for lesions involving the head, neck, or torso, as the reconstructive outcome, particularly in the head and neck, is far superior to that obtained with skin grafting 14,15 . On the other hand, the use of this technique on giant nevi located on arms or legs should be considered carefully because of the restricting circumference of skin envelope, resulting in increased morbidity of the expanded tissue 12 .…”

Early curettage of giant congenital naevi in children

“…The treatment of GCN remains controversial: tangential excision, 7,8,10 dermabrasion 7 and curettage 10 produce a cosmetic improvement and of these, curettage is the least traumatic. [11][12][13][14][15][16] Early procedures to remove the superficial layers of these naevi have been developed. 1,3,5,7,8,10,17,18 In agreement with other series, 3,10,19 curettage seemed to be both the least traumatic and easiest to perform, being particularly effective when performed during the first 15 days after birth.…”

Autologous Cultured Skin Substitutes Conserve Donor Autograft in Elective Treatment of Congenital Giant Melanocytic Nevus

“…The time required to inflate tissue expanders and the limited area of expansion reduce their effectiveness and increase risks of morbidity in large lesions. 6,8,9 Expanders also have unacceptably high complication rates when used on the extremities or in the perineum. Because of these limitations, traditional split-thickness skin grafting techniques remain an acceptable alternative despite the resultant donor-site morbidity.…”

“…Because of these limitations, traditional split-thickness skin grafting techniques remain an acceptable alternative despite the resultant donor-site morbidity. 8,9 Although attempts have been made in the past to use cultured keratinocytes in monolayer for wound coverage, the results were clinically unacceptable. These monolayers of cells have poor long-term durability, a propensity to hypertrophic scarring and inferior cosmesis relative to traditional autografts.…”

“…Tissue expanders are prosthetic devices that gradually stretch the surrounding normal skin to provide tissue for wound coverage. 8,9 The expanded skin is fullthickness, well-vascularized tissue that provides a good color and texture match. It is more aesthetically appealing than split grafts because scarring is limited to linear incisions as opposed to large areas of donor sites.…”