eMedicine Specialties > Dermatology > Pediatric Diseases

Congenital Nevi: Treatment & Medication

Author: Christopher J Steen, MD, Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Coauthor(s): Jerry Rothenberg, MD, Clinical Associate Professor, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; President, Director, New Jersey Dermatopathology Laboratory, Inc; Isabelle Thomas, MD, Associate Professor, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; Chief of Dermatology Service, Veterans Affairs Medical Center of East Orange; Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Apr 24, 2009

Treatment

Medical Care

The management of congenital melanocytic nevi depends on a number of factors, including the size of the lesion, the location of the lesion, the age of patient, the effect on cosmesis, and the potential for malignant transformation.

Although the risk of malignant transformation in small and medium-sized congenital melanocytic nevi has not been established, many physicians agree that the risk is probably not significant enough to warrant the prophylactic removal of all of these lesions. However, some patients may desire removal of these lesions to improve cosmesis.19 Until evidence is presented on which to base definitive treatment guidelines, many physicians are managing small and medium-sized congenital melanocytic nevi with baseline photography and regular follow-up.

Surgical Care

Surgical removal of congenital melanocytic nevi is performed for 2 main reasons, (1) to improve the cosmetic appearance of the patient and (2) to reduce the likelihood of malignant transformation. The increased risk of malignant transformation associated with giant congenital melanocytic nevi is well established. Ideally, these lesions are removed whenever possible. Barriers to removal may include the size of the lesion and its proximity to vital structures. Several different procedures are available to remove these lesions.20

  • Surgical excision of giant congenital melanocytic nevi, depending on the size and location of the lesion, may be challenging. Often, the size of the lesion necessitates a staged excision. Tissue expanders, tissue grafts, and tissue flaps are often necessary to close the large defects following excision. Cultured skin replacements have also been used in the closure of surgical wounds.21 Because the melanocytes in such cases may extend deep into underlying tissues (including muscle, bone, and central nervous system), removing the cutaneous component may not eliminate the risk of malignancy.
  • Curettage of the lesions may be performed during the neonatal period,22 but long-term studies suggest the nevus will, in part, recur. This is likely due to those components of the epidermis that are deep to the level of curettage.
  • Laser treatment of the lesions has been performed with a number of different types of lasers, including the systems noted below. Because of the lack of penetrance to deeper tissue levels, long-term recurrence is also an issue with these techniques. Laser treatment of congenital melanocytic nevi also remains controversial for a variety of reasons. The effects of sublethal laser fluences on the risk of malignant transformation of melanocytes are uncertain. Additionally, while the destruction of more superficial melanocytes may improve cosmesis, if melanoma does develop in a laser treated lesion, it may be more likely to occur deeper in the tissue where it may evade clinical detection until it reaches a more advanced stage. 
    • High-energy pulsed carbon dioxide laser23,24,25,26
    • Erbium:YAG laser24,27
    • Normal-mode ruby laser24,28,29
    • Q-switched ruby laser24,29,30
    • Switched alexandrite laser26,28,31

Consultations

Because of the risk of neurocutaneous melanosis in patients with giant congenital nevi or multiple smaller congenital nevi, consultation with a neurologist, pediatrician, or both may be useful to detect possible early neurologic manifestations of the disease. Even in the absence of malignancy, neurocutaneous melanosis may cause problems such as obstructive hydrocephalus.

Diet

No specific dietary recommendations are necessary for patients with congenital nevi.

Activity

No specific activity restrictions are necessary for patients with congenital nevi. However, because of the increased risk for the development of melanoma, especially in patients with giant congenital nevi, proper protective measures should be taken to minimize ultraviolet light exposure. Maintaining the ability to take part in normal activities should be a consideration when planning surgical removal of a congenital nevus.

More on Congenital Nevi

Overview: Congenital Nevi
Differential Diagnoses & Workup: Congenital Nevi
Treatment & Medication: Congenital Nevi
Follow-up: Congenital Nevi
Multimedia: Congenital Nevi
References
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References

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  13. Wu PA, Mancini AJ, Marghoob AA, Frieden IJ. Simultaneous occurrence of infantile hemangioma and congenital melanocytic nevus: Coincidence or real association?. J Am Acad Dermatol. Feb 2008;58(2 Suppl):S16-22. [Medline].

  14. Zaenglein AL, Heintz P, Kamino H, Zisblatt M, Orlow SJ. Congenital Spitz nevus clinically mimicking melanoma. J Am Acad Dermatol. Sep 2002;47(3):441-4. [Medline].

  15. Changchien L, Dusza SW, Agero AL, et al. Age- and site-specific variation in the dermoscopic patterns of congenital melanocytic nevi: an aid to accurate classification and assessment of melanocytic nevi. Arch Dermatol. Aug 2007;143(8):1007-14. [Medline].

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  31. Kim S, Kang WH. Treatment of congenital nevi with the Q-switched Alexandrite laser. Eur J Dermatol. Mar-Apr 2005;15(2):92-6. [Medline].

  32. MacLachlan WWG. Extensive pigmentation of the brain associated with nevi pigmentosi of the skin. J Med Res. 1913;29:433-47.

  33. Marghoob AA. Congenital melanocytic nevi. Evaluation and management. Dermatol Clin. Oct 2002;20(4):607-16, viii. [Medline].

  34. Patterson WM, Lefkowitz A, Schwartz RA, Lambert WC, Rao BK. Melanoma in children. Cutis. May 2000;65(5):269-72, 275. [Medline].

  35. Wiltz H, Kollmer WL, Rauscher GE, Sharma PK, Cohen PJ, Schwartz RA. Excision of the large congenital melanocytic nevus facilitated by the use of the tissue expander. J Surg Oncol. Jun 1988;38(2):104-7. [Medline].

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Further Reading

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Keywords

congenital nevi, congenital melanocytic nevi, congenital nevus, nevocellular nevi, nevocellular nevus, garment nevus, garment nevi, giant hairy nevus, giant hairy nevi, bathing-trunk nevus, bathing trunk nevus, bathing trunk nevi, bathing-trunk nevi, giant pigmented nevus, nevus pigmentosus et pilosus, giant pigmented nevi, neurocutaneous melanosis, melanoma, melanoma risk factors, skin cancer

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Contributor Information and Disclosures

Author

Christopher J Steen, MD, Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Christopher J Steen, MD is a member of the following medical societies: Alpha Omega Alpha and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Jerry Rothenberg, MD, Clinical Associate Professor, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; President, Director, New Jersey Dermatopathology Laboratory, Inc
Disclosure: Nothing to disclose.

Isabelle Thomas, MD, Associate Professor, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; Chief of Dermatology Service, Veterans Affairs Medical Center of East Orange
Isabelle Thomas, MD is a member of the following medical societies: American Academy of Dermatology and Sigma Xi
Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Franklin Flowers, MD, Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, University of Florida College of Medicine
Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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