[Surgical treatment of giant congenital melanocytic nevi: a change of aim]. / Tratamiento quirúrgico del nevus melanocítico gigante: un cambio de objetivo.

OBJECTIVE: To review the surgical experience in Giant Congenital Melanocytic Nevi (GCMN). MATERIAL AND METHODS: Review of GCMN cases consulting at the Department of Pediatric Surgery since 1994. Data registered were: year and age at 1st consultation, type of treatment, number of surgical procedures and complications, histology, central nervous system MRI and follow-up. RESULTS: Eleven patients with GCMN > 10% of body surface consulted at ages ranging from newborn to 8 years. All of them had multiple surgical procedures (2-19), from nevus removal to only biopsies. Eight patients had tissue expansion, completed in 3 of them with skin grafts on dermal substitute. Six patients had complications: 4 expander extrusions, 5 infections, 3 flap necrosis and 1 dehiscence. In 6 children a total or subtotal resection of the nevus was achieved; in 2 the treatment was interrupted, remaining 20% and 50% of the initial nevus; three patients had not had nevus treatment. None of the patients presented cutaneous melanoma; one died from intracranial melanoma; another one has leptomeningeal melanosis. The first 4 patients underwent an average of 16 surgical procedures each, the last 7 patients only 5. CONCLUSIONS: The aim of GCNM management has changed: GCNM treatment is now surgically conservative. Complete excision is now not the aim when technically unfeasible in few procedures; multiple surgical procedures with poor cosmetical results are not acceptable. The gravity is determined by CNS involvement.

Tratamiento quirúrgico del nevus melanocítico gigante: un cambio de objetivo / Surgical treatment of giant congenital melanocytic nevi: a change of aim

Objetivo. Revisión de la experiencia quirúrgica en Nevus Melanocítico Gigante Congénito (NMGC).Material y métodos. Revisión de los casos de NMGC que consultarona cirugía pediátrica desde 1994, recogiendo: año y edad en la 1ªconsulta, tipo de tratamiento, número de intervenciones, complicaciones, histología, RM de SNC y evolución. Resultados. Once pacientes con NMGC >10% de la superficie corporal consultaron entre el nacimiento y los 8 años y fueron sometidos a alguna intervención (2 a 19), desde exéresis hasta sólo biopsias. En 8 niños se utilizaron expansores y plastias, y en 3 de ellos injertos de piel sobre sustituto dérmico; en 6 hubo complicaciones: 4 extrusiones, 5 infecciones,3 necrosis de colgajo y 1 dehiscencia. En 6 niños se consiguió la exéresis total o subtotal del nevus, en 2 se ha interrumpido el tratamiento, quedando 20% y 50% del nevus; tres niños no se trataron del NMGC. Ningún paciente ha presentado melanoma cutáneo; uno falleció de melanoma intracraneal y otro presenta melanosis leptomeníngea. La media de intervenciones de los 4 primeros pacientes fue de 16 y en los 7 últimos fue de 5.Conclusiones. Los objetivos del tratamiento han variado: el tratamiento del NMGC es quirúrgicamente más conservador; las exéresis completas ya no se indican si no son técnicamente posibles en pocos pasos; no es aceptable un resultado cosmético inadecuado tras una infancia lastrada por múltiples intervenciones. La gravedad la confiere la afectación del SNC

Objective. To review the surgical experience in Giant Congenital Melanocytic Nevi (GCMN).Material and Methods. Review of GCMN cases consulting at the Department of Pediatric Surgery since 1994. Data registered were: year and age at 1st consultation, type of treatment, number of surgical procedures and complications, histology, central nervous system MRI and follow-up. Results. Eleven patients with GCMN >10% of body surface consulted at ages ranging from newborn to 8 years. All of them had multiple surgical procedures (2-19), from nevus removal to only biopsies. Eight patients had tissue expansion, completed in 3 of them with skin grafts on dermal substitute. Six patients had complications: 4 expander extrusions, 5 infections, 3 flap necrosis and 1 dehiscence. In 6 children a total or subtotal resection of the nevus was achieved; in 2 the treatment was interrupted, remaining 20% and 50% of the initial nevus; three patients had not had nevus treatment. None of the patients presented cutaneous melanoma; one died from intracranial melanoma; another one has leptomeningeal melanosis. The first 4 patients underwent an average of 16 surgical procedures each, the last 7 patients only 5. Conclusions. The aim of GCNM management has changed: GCNM treatment is now surgically conservative. Complete excision is now not the aim when technically unfeasible in few procedures; multiple surgical procedures with poor cosmetical results are not acceptable. The gravity is determined by CNS involvement