Indications for excision of nevi and melanoma diagnosed in a pediatric surgical unit

Surgical Treatment of Nevi and Melanoma in the Pediatric Age

“…Nonetheless malignancy is reported to occur despite complete excision and may be not preventable [34,35] Indications for surgical excision [36] of acquired nevi are mainly related to lesions resembling malignant melanoma, such as atypical nevi, Spitz nevi, and lesions presenting clinical signs and symptoms as diameter of more than 5 mm or increasing diameter, irregular margins, border notching, irregular pigmentation, asymmetry, rapid onset or increase in diameter, ulceration, bleeding, pain and itching. These last signs seem to represent the presentation symptoms of malignant melanoma in 85% of cases [37] Although the risk of malignant melanoma is higher in familial atypical nevi rather than in nonfamilial, features of atypical nevi have been reported to be the most frequent indication to surgery [38] Some special consideration is given to Spitz nevus for possible misdiagnosis with MM. Most dermatologists and physicians recommend biopsy.…”

“…In some cases nevi located in sites of clinically difficult monitoring or placed in sites of exposure to frequent trauma are an indication for excision [38,40]…”

“…whereas others advocate clinical monitoring of small [38] or both small and medium nevi [43] The incidence of malignant melanoma appears higher in large congenital nevi, in the scalp, back, and buttocks and requires removal first. This increase in incidence is likely secondary to the total body surface area.…”

“…Elective regional lymph node dissection is subsequently performed if the result of the SLNB is positive for metastases [38].…”

“…After diagnosis of melanoma, the patient undergoes SLNB for tumour thickness ≥ 1 mm followed by wide excision of the tumour site with 2 cm margins and primary closure or skin graft. SLNB is performed using preoperative lymphoscintigraphy, intraoperative blue dye injection around the site of excision and hand-held gamma probe for radio-localization [38,88]. One day before the operation, between 18.5 and 40 MBq of Tc-99m microcolloid is injected intradermally around the scar.…”