Resurfacing of Sleeve-Like Circumferential Giant Congenital Melanocytic Nevi on the Upper Extremity With Pre-Expanded Pedicled Flap.

As the relative shortage of healthy tissue obviates the option of local soft tissue coverage, reconstruction of circumferential giant congenital melanocytic nevi (GCMN) on the upper extremity remains particularly challenging. Here the authors report a 3-stage procedure involving pre-expanded pedicled flap from the torso for the reconstruction of upper extremity after circumferential GCMN excision in pediatric patients. The giant nevus was completely removed and the size of the excised nevus was 31 × 14.5 cm. The donor site was primarily closed. No major complication was encountered. Reconstruction with expanded pedicled flap achieved satisfactory results, both functionally and cosmetically.

Clinical features and management of eyelid margin nevi.

PURPOSE: Acquired melanocytic nevi are common eyelid lesions; however, their clinical presentation is not well documented. METHODS: In this retrospective study, clinical records were reviewed in patients evaluated between 2005 and 2022. RESULTS: Eyelid margin nevi (n = 150) were more commonly excised in female (78%) and Caucasian (86%) patients. Change in appearance/size were frequent presenting complaints, and 17% experienced ocular symptoms. Referring diagnosis included other benign lesions (11.3%), and concern for malignancy (16.7%). Many individuals (38.7%) noted their lesion for ≤5 years. Nevi were distributed across the 4 margins (9% peripunctal), and 88% had a regular base. Visible pigmentation was more common in non-Caucasians (95.2%) than Caucasians (41.1%). Lashes grew through 60.7% of nevi and were often misdirected.Nevi were treated with superficial excision and cauterization. Histologic subtypes included: dermal (86.6%), compound (9.4%), blue (2.7%), junctional (0.7%), lentiginous dysplastic (0.7%). An irregular base (p=0.042) and pigmentation (p=0.056) were more common in compound than dermal nevi. Lash line quality and appearance were improved in the majority of patients returning for follow-up, although postoperative trichiasis, marginal erythema, and residual pigmentation were observed. CONCLUSIONS: Melanocytic nevi commonly involve the eyelid margins and have a variety of presentations and appearances. Existing nevi can change, and new lesions appear throughout adulthood. Stable, benign appearing nevi can be observed. Shave excision provides a diagnosis and improved appearance for symptomatic or suspicious lesions, with few serious complications. Malignant transformation is rare, although evidence for recurrence warrants further evaluation.

Reconstruction of Hemifacial Congenital Giant Nevus with Pre-expanded Scalp Flaps and Deltopectoral Skin Flaps.

BACKGROUND: The hemifacial congenital giant nevus impacts both physical and mental health of the patients. Excision is typically the most suitable option in these situations, but reconstructing the subsequent surgical defects is always a serious challenge. METHODS: Between February 2012 and January 2021, a retrospective review of 4 patients who suffered from hemifacial congenital giant nevus was conducted, and they were treated by pre-expanded scalp flap and deltopectoral flap simultaneously. All patients receive tissue expansion, nevus resection, expanded skin flap transfer, and pedicle division. RESULTS: Four patients with hemifacial congenital giant nevi were successfully treated with no major complications. One patient with a transferred deltopectoral flap experienced distal necrosis of the flap, and healed after dressing changes. No recurrence of the nevus was found during the follow-up period, and the transferred skin flaps match well with facial skin in contour and color. CONCLUSION: This modified pre-expanded scalp flap combined with a deltopectoral flap provides an easy and reliable way for hemifacial reconstruction in patients with a congenital giant nevus.

[Surgical treatment of nevi in children in a dermatological surgery center : Histopathology and complications]. / Operative Therapie von Nävi bei Kindern in einem dermatochirurgischen Zentrum : Histopathologie und Komplikationen.

BACKGROUND: The indication for surgical management and histological diagnosis of melanocytic nevi in children is a major challenge in clinical routine. In consultations with children and parents, the exclusion of malignant findings, on the one hand, and the risk of complications, on the other hand, are important. PATIENTS AND METHODOLOGY: Included were 946 children under the age of 10 years who underwent surgery with a suspected diagnosis of melanocytic nevus at the University Department of Dermatology, Tübingen, Germany, between 2008 and 2018. Dermatohistopathologic findings and postoperative complications were recorded. RESULTS: A clinical diagnosis of melanocytic nevus was histologically confirmed in 93.2% (882/946) of cases, whereby there were 41 Spitz nevi and 18 pigmented spindle cell tumors. Melanoma was diagnosed in 2 of the children (0.2%). In another 6.6%, non-melanocytic findings (e.g., nevus sebaceous, epidermal nevi) were diagnosed. The complication rate was low at 3%. The most common complication was the occurrence of postoperative wound infection in 1.7%. CONCLUSION: It is possible to take a biopsy or surgically remove congenital nevi of different sizes even in infants. Serial excision of congenital nevi is an important tool for this purpose. In the investigated cohort, the complication rate was low. Histological confirmation is essential in case of clinically suspicious or atypical findings.

Efficacy of non-ablative 1927-nm fractional thulium fiber laser for the treatment of Becker's nevus: Intra- and interobserver agreement study.

OBJECTIVE: To assess the efficacy and safety of a 1927-nm fractional thulium fiber laser treatment for Becker's nevus. METHODS: A retrospective analysis of patients with Becker's nevus who were treated with a 1927-nm fractional thulium fiber laser was conducted. Grading for lightening was set quarterly by physician global assessment of the pre- and postphotographs (I: <25%; II: 25%-50%; III: 51%-75%; and IV: >75% for marked lightening). Grading validation was exercised using intra- and interobserver agreement analysis among 10 dermatologists to determine the percent of agreement and the intraclass correlation coefficient. Grades I and II were classified as treatment failure. RESULTS: A total of 21 patients were recruited for analysis. The average number of treatment sessions was 2.1 per patient. A total of 13 patients achieved successful outcomes (grades III and IV) while 8 patients experienced treatment failure (grades I and II). Partial recurrence and transient hypopigmentation on adjacent skin were the main adverse effects. Only one patient reported worsening of the nevus. Overall agreement among the raters for the outcomes was graded from "very good" to "excellent," and the intraclass correlation coefficient, kappa, was 0.8. CONCLUSION: A 1927-nm fractional thulium fiber laser may be effective to ameliorate the pigment of Becker's nevus and achieve acceptable cosmetic outcomes. However, further studies are required in this area to improve and optimize the results.

Tumescent local anaesthesia for the surgical therapy of congenital nevi in the first year of life.

BACKGROUND: The indication for surgical treatment of congenital nevi must be made after individual consideration of the expected benefit and risk and requires careful information of the parents as well as interdisciplinary psychological support. In addition to suspected malignancy, a relevant indication is the risk of stigmatization depending on the size and localization of the nevus. Objective was to show which size reduction of the congenital nevus can be achieved by surgical therapy under tumescent local anaesthesia (TLA) in infancy and how often complications of anaesthesia or surgery occur. METHODS: All infants up to 12 months of age who underwent surgery for a congenital nevus under TLA at the University Dermatological Clinic Tuebingen between January 2015 and December 2021 were included; surgeries were performed using serial excisions (powerstretching technique), whereby the incisions were made inside the nevus and mobilization was strictly limited to the skin side without nevus. RESULTS: Overall, a cumulative total area of 38.65 cm2 could be removed on average within the first year of life (trunk: 67 cm2 , head: 21.2 cm2 , legs: 21.6 cm2 , arms: 13.2 cm2 ). A cumulative maximum area reduction of 406.9 cm2 could be achieved. We evaluated 363 surgical sites (123 children) on all body regions. The median age of the children at the first surgery was 3.5 months (0.46-10.7 months). Complications occurred in 2.3% (seven procedures). All these complications were reversible in the course of the operation and did not lead to a prolonged hospital stay. No anaesthesia-related complications occurred. CONCLUSION: We were able to show that a reduction of large areas of congenital nevi is possible in the first year of life with the combination of serial excisions using powerstretching technique, TLA, and intracutaneous butterfly sutures.

Myocutaneous sliding flap for reconstruction of divided eyelid nevus.

OBJECTIVE: To evaluate the myocutaneous sliding flap for restructuring the eyelid of divided nevus, thus optimizing the aesthetic outcome. DESIGN: A retrospective clinical study. PARTICIPANTS: Clinical data from patients with a small or medium-sized divided nevus of the eyelids between January 2015 and December 2018 in the Shanghai Ninth People's Hospital were reviewed. METHODS: The safety and efficacy of a surgical approach using a myocutaneous sliding flap were evaluated based on postoperative features and complications. RESULTS: This study included 53 patients with an average age was 21.6 years (range, 2-68 years). The lesions involved the inner canthus in 5 patients (9.43%) and the lateral canthus in 14 patients (26.42%). Three (5.66%) patients had undergone primary surgery elsewhere. Overall, the eyelid margins were in good shape postoperatively at an average follow-up of 22.7 months, and there were no obvious eyelid deformities, lagophthalmos, or other unacceptable complications postoperatively. The nevi were benign intradermal (60.38%), junctional (16.98%), and compound types (22.64%) without malignant transformation, as confirmed by pathologic examination. No malignant transformation was observed until the end of the follow-up period. CONCLUSION: A myocutaneous sliding flap can provide an appropriately size pedicle graft and achieve satisfactory cosmetic results for divided eyelid nevus.

Combination 1550 nm non-ablative fractional resurfacing and laser hair removal for treatment of Becker's nevi in skin types III-VI.

OBJECTIVES: Becker's nevus is a cosmetically bothersome benign hamartoma typically associated with basal layer hyperpigmentation and hypertrichosis. We herein present the largest case series characterizing treatment parameters and clinical outcomes of combined 1550 nm non-ablative fractional resurfacing and laser hair removal (long-pulsed neodymium-doped yttrium aluminum garnet or alexandrite) in the treatment of Becker's nevus. This is also the largest case series of laser treatment of Becker's nevus in Fitzpatrick skin types V and VI. METHODS: We performed a retrospective review of patients treated between 2016 and 2021. Clinical photographs were graded by three independent physicians using a 5-point visual analog scale. RESULTS: Twelve patients (mean age: 24.8 years, Fitzpatrick skin types III-VI) were treated for Becker's nevus on the face (4) or the trunk and/or extremities (8). Four patients were Fitzpatrick skin types V or VI. On average, patients received 5.3 treatments in 1-4-month intervals. Ten of the 12 patients had concomitant laser hair removal preceding same-day non-ablative fractional resurfacing (n = 7 with long-pulsed 1064 nm neodymium-doped yttrium aluminum garnet and n = 3 with long-pulsed 755 nm alexandrite). The number of treatments with each modality was determined by patient satisfaction with improvement in hyperpigmentation and hypertrichosis. At follow-up, which ranged from 6 to 40 weeks (mean 10.5 weeks), patients were given a mean improvement score of 51%-75%. No long-term adverse events were encountered in either group. Limitations include a small sample size and a lack of long-term follow-up. CONCLUSION: Combination 1550 nm non-ablative fractional resurfacing and laser hair removal is safe and efficacious in the cosmetic reduction of hyperpigmentation and hypertrichosis associated with Becker's nevus, including those with Fitzpatrick skin types V and VI.

A simple method for eyelid reconstruction with an advancement flap after resection of a minor nevus on the eyelid margin.

We developed a simple and effective method for eyelid reconstruction after resection of a minor nevus on the eyelid margin. With a vertical advancement flap to repair the defect, all patients were satisfied with the cosmetic and functional results of the eyelids, and no significant complications occurred.

Histopathologic reassessment of melanoma and other melanocytic skin lesions excised in 2009 and 2018-2019. / Histopatologisk revurdering av melanom og andre melanocytære hudlesjoner eksidert i 2009 og 2018­19.

BACKGROUND: Histopathological assessment of melanoma and other melanocytic skin lesions can be difficult and can vary between pathologists. MATERIAL AND METHOD: Histopathological slides of 196 melanocytic skin lesions from 2009 and 2018-2019 were obtained from the archive of the Department of Pathology at Oslo University Hospital and classified into six diagnostic categories: 1) benign nevus, 2) irregular/dysplastic nevus, i.e. dysplastic nevus with moderate atypia, 3) nevus with severe atypia, i.e. dysplastic nevus with severe atypia, 4) melanoma in situ, 5) superficial spreading or lentiginous melanoma and 6) nodular melanoma. The slides were then examined independently and blindly by three experienced pathologists and categorised in the same way. Interobserver agreement was assessed with Cohen's kappa, and agreement with the original diagnosis was assessed by the proportion of assessments in the same diagnostic category. RESULTS: The kappa values for the assessments from the three pathologists ranged from 0.45 to 0.50. The proportion of reassessments in agreement with the original diagnostic category was 85.7 % (95 % CI 75.7 to 92.1), 29.2 % (19.9 to 40.5), 27.8 % (20.9 to 36.0), 78.3 % (70.4 to 84.5), 81.2 % (73.7 to 86.9) and 93.3 % (82.1 to 97.7), respectively, i.e. highest for nodular melanoma. The proportion of reassessments in which the diagnosis was more serious or less serious than the original diagnosis was higher and lower, respectively, for slides from 2009 than for slides from 2018-2019. INTERPRETATION: The differences between the pathologists' assessments and deviations from the original diagnoses can be explained by poorly reproducible diagnostic criteria, diagnostic entities with overlapping morphology and increasing awareness of early signs of malignancy. Some evolution in diagnostic practice cannot be ruled out.

[A new classification method of eyelid divided nevi and the effect of plastic surgical treatment].

Objective: To classify the eyelid divided nevi using a new classification method, and to observe the distribution characteristics and surgical effects of these nevi. Methods: It was a retrospective case series study. Thirty-nine cases (39 eyes) of eyelid divided nevus treated at Beijing Tongren Hospital affiliated to Capital Medical University were collected between October 2015 and January 2020. A new classification method, namely traditional classification combined with aesthetic unit classification, was used to classify eyelid divided nevi. According to different classifications, the corresponding surgical treatment methods were adopted. The distribution characteristics of different types of eyelid divided nevi were summarized, as well as the effects of plastic surgery. Results: Thirty-nine patients were affected unilaterally, including 26 females (67%) and 13 males (33%), aged (31.1±17.8) years. There were 5 cases (13%) of localized, 6 cases (15%) of a moderate range and 2 cases (5%) of a large range medial eyelid divided nevus respectively. There were 6 cases (15%) of localized and 3 cases (8%) of a moderate range central eyelid divided nevus, respectively. There were 4 cases (10%) of localized and 6 cases (15%) of a moderate range lateral eyelid divided nevus, respectively. There were 2 cases (5%) of a moderate range and 5 cases (13%) of a large range total eyelid divided nevus, respectively. Pathological results revealed 20 cases of intradermal nevus (51%), 18 cases of compound nevus (46%) and 1 case of boundary nevus (3%). After 6 months to 2 years of observation, the patients' appearance was satisfactory. The treatment results were excellent in 36 cases (92%) and good in 3 cases (8%). Even though the pigmented nevus at the eyelid margin recurred in two cases (5%), there was no recurrence after reoperation. Conclusions: Medial and moderate-range eyelid divided nevi are more common, and the traditional classification combined with aesthetic unit classification is more accurate for the classification of eyelid divided nevi. Different types of eyelid divided nevi can be treated by corresponding surgical methods with satisfactory results.

[Lipomodeling for congenital breast deformities: Technique, results and indications]. / Place des transferts graisseux dans les malformations des seins et du thorax.

Congenital breast deformities usually occur during adolescence and can disturb the self-development and affect the identity during this crucial stage. Several surgical techniques are now available to correct these different anomalies. The objective is to clarify the place of lipomodeling in thoraco-mammary malformations, resuming the different indications, the results, as well as the limits and potential complications. The adipose tissue was harvested by soft aspiration as to reduce adipocyte trauma and using a syringe fitted with a 3.5mm cannula. After centrifugation, fat was reinjected retrogradely and by making thin cylinders of fat similar to "spaghetti". Moderate to severe asymmetry is one of the best indications for lipomodeling using one or two sessions. Thus, a perfect and lasting symmetry is achieved, without the need of an implant, which would inevitably leads to asymmetry because of a dissimilar evolution of the breast all over the time. In Becker's nevus syndrome, lipomodeling has also been performant in bluring the hyperpigmentation of the nevus. The role of lipomodeling in pectus excavatum deformity (antero-posterior sternocostal depression) is also crucial. Lipomodeling can be used alone, or in combination with a rigid customed silicone implant. Tuberous breasts include various anomalies. Lipomodeling is currently used especially when the anomaly is unilateral (2 fat graft sessions are usually needed). Fasciotomies are frequently performed too. Lipomodeling is a real revolution in the management of Poland syndrome (anomaly characterized by the unilateral lack of the pectoralis major muscle, more or less associated with other ipsilateral anomalies). On average, 3 to 5 sessions are necessary to obtain a suitable symmetry. Lipomodeling is very unlikely to cause major surgical complications. Cytosteatonecrosis nodules mainly occur with novice practitioner and decrease as they become more experienced. However, the principle of the three-dimensional network, and the phenomenon of tissue saturation of the recipient site should be respected. The main limitation of lipomodeling is directly related to the amount of fat available. That's why it is very important to evaluate it during the first clinical consultation, and to carefully select the patients eligible in order to limit the risk of failure. Lipomodeling of congenital breast anomalies is a technique well established, with a precise algorithm to follow, and is a procedure with low surgical risk, less scarring, cosmetic and lasting results. This technique is to be suggested as a first line treatment in all indications of congenital breast deformities, alone or combined to an implant. Therefore, it seems essential that a plastic surgeon fully master the indications and the use of fat tissue transfer procedure, in order to obtain natural and harmonious results.

Application of allogeneic sclera combined with tarso-conjunctival flap in total excision of divided eyelid nevus.

OBJECTIVE: To explore the clinical effect of allogeneic sclera transplantation combined with tarso-conjunctival flap in total excision of divided eyelid nevus. METHODS: Eleven patients (three male and eight female patients) who experienced divided nevus of the eyelids between January 2014 and April 2020 were recruited to this retrospective study. All lesions were thick, darkly pigmented, presented with a wart-like appearance, and invaded the eyelid margin and tarsal conjunctiva. The surgical method involved a full-thickness lesion excision; then, the posterior defect was reconstructed by sliding the residual tarso-conjunctival flap forward and allogeneic sclera transplantation, and the anterior defect was reconstructed with sliding flaps, rotating flaps, and free skin grafts. RESULTS: Neither malignant transformations nor recurrences were observed after a follow-up of more than one year. The eyelid shape was normal, the rim of the eyelid was smooth, there was no dissolution or rejection of the allogeneic sclera, and the eyelid had good mobility. All the flaps used were viable, soft, and thin. The most frequent complication was the loss of eyelashes in the reconstructed area. CONCLUSION: For divided nevus of the eyelids invaded the eyelid margin and tarsal conjunctiva, total excision is a better decision, regardless of tumor recurrence or aesthetic considerations. The posterior defect reconstruction through sliding residual tarso-conjunctival flaps combined with allogeneic sclera transplantation is simple and effective.

Use of intercostal nerve block for chest wall pain in a patient with CLOVES syndrome.

Congenital lipomatous overgrowth, vascular malformations, epidermal nevi and scoliosis/skeletal/spinal anomalies (CLOVES) syndrome is an extremely rare overgrowth syndrome characterized by complex vascular malformations. Management requires an interdisciplinary approach including debulking operations for tissue overgrowth, embolization therapy for vascular malformations and management of chronic pain due to congenital and recurrent vascular overgrowth and from scar tissue from surgical interventions. Here, we present a 35-year-old female with complex medical history due to CLOVES syndrome, with large vascular malformations on her chest, status post debulking/embolization previously and now with continued chronic nociceptive and neuropathic pain, largely due to the recurrent nature of vascular malformations, but now finding some relief with fluoroscopy-guided intercostal nerve blocks which she never experienced before.

Expanded scalp flap combined with laser hair removal to reconstruct facial defects around the hairline.

BACKGROUND: Congenital and acquired facial lesions around the hairline can bring huge physical and psychological trauma to patients. At present, reconstruction of this area remains a challenge. In this study, we present an alternative technique to reconstruct the aesthetic units using an expanded scalp flap combined with laser hair removal. METHODS: We retrospectively reviewed 25 cases of facial lesions around the hairline reconstructed with this surgical technique between May 2014 and May 2020. Expander was implanted under the scalp as designed before the operation. After the expander was fully expanded, the lesion was removed and the scalp flap was transferred. Laser hair removal was performed on the transplanted skin flap 2 weeks after flap transfer. RESULTS: There were ten cases of postburn scar, nine cases of congenital nevus, four cases of traumatic scar, one case of haemangioma, and one case of nevus sebaceous. The median times of laser treatment was 3 (range, 1-8). The median follow-up time was 11 months, ranging from 1 to 27 months. The colour and texture of expanded flaps were similar to adjacent tissue in all cases. The direction of reserved hair in transferred flaps was consistent with the direction of hair in the recipient area or contralateral hair. There were no complications, such as infection, blistering, discolouration, and ulceration. All patients were satisfied with the appearance of the reconstructed hairline and the surgical outcomes. CONCLUSIONS: The expanded scalp flap combined with laser hair removal is a feasible and effective technique to reconstruct both sides of the hairline simultaneously from a single donor site with a good colour match and a similar texture and thickness.

The Beneficial Effect on Pigmentation Using Laser Epilation as an Initial Treatment Approach for Becker's Nevus in Asian Skin.

Becker's nevus (BN) clinically presents as brown patches with hypertrichosis. The risk of pigmentary changes still remains a concern when using lasers to treat Asian patients with BN. We aimed to evaluate the outcomes on reduction of hairs and pigment of BN using the long-pulsed 1064-nm Nd:YAG (LPNY) and/or 755-nm alexandrite (LP-Alex), before treating pigment in earnest. A total of 13 subjects were treated with the LPNY (n = 8), the LP-Alex (n = 4), and both (n = 1). Improvements on hair removal and pigment reduction were assessed using a 5-point global assessment scale. Patient satisfaction was also assessed. Treatment parameters were within those commonly used for the purpose of epilation. The average follow-up period was 19.5 ± 12.3 weeks, and the mean total number of sessions was 2.0. Eleven subjects reported >50% improvement in hair removal (11/13, 86.7%), and pigment reduction of >50% improvement was observed in 9 subjects (9/13, 69.2%). Patient satisfaction showed >50% lesion clearance in 84.6%. Hair removal settings of LPNY and LP-Alex were effective in both hypertrichosis and pigment reduction in the initial strategy of treatment of BN in skin of color.

A giant epidermal nevus of the face treated with a CO2 and dye laser combination: a case report and literature review.

Epidermal nevi (EN) are cutaneous hamartomas present at birth, usually occurs in the trunk, the face, or the limbs, appearing as a patch of overgrowing skin. They may be small and localized, but they may interest extensive areas of the body. A 20 years old man came to our attention for an EN interesting all the face. The treatment protocol consisted of a session of CO2 laser in order to vaporize thicker areas, followed by a session of dye laser on the area to prevent scarring. This treatment was performed under local anesthesia and sedation in three surgical sessions spaced 3 months from each other. Two sessions of dye laser spaced apart 6 months were performed during follow-up to further improve the esthetic outcome. The patient was followed for 2 years with no recurrence. Although surgery is still considered the gold standard in EN management, it is not always feasible. This novel combination technique can obtain optimal cosmetic results with no relapse within the period of follow up. Although further trials on a more significant number of patients are required, the combination of CO2 and dye laser promises to become a valid therapeutic alternative when treating giant EN of the face.

A rare case of nevus sebaceous of the bilateral labia minora: A case report and review of literature.

RATIONALE: Nevus sebaceous (NS) is a lesion caused by congenital hyperplastic disorder of the sebaceous glands. It commonly noted in the scalp and face and rarely in the trunk, neck, or oral mucosa. We present a rare case of a lesion arising in the genital region. PATIENT CONCERNS: A 47-year-old woman complained of a gradual increase in the size of her bilateral labia minora over 2 years, which affected her sexual life and caused walking difficulty. She was admitted to the Department of Obstetrics and Gynecology. On physical examination, no ulcer, discharge, and vulval or vaginal bleeding were found. The bilateral inguinal lymph nodes were not palpable, bilateral labia minora were asymmetric, and the right side was evidently bigger than the left. The labia minora had serrated edges and numerous papillae with a maximum diameter of 0.5 cm. The vagina, cervix, and uterus with its attachments were normal. Blood samples tested negative for human immunodeficiency virus, human papilloma virus, hepatitis B virus, and hepatitis C virus. DIAGNOSIS: A diagnosis of NS of the bilateral labia minora was made following histopathological examination of the resected specimen. INTERVENTION: The bilateral labia minora lesions were resected general anesthesia on August 29, 2016. The operation was successful, and intraoperative blood loss was about 10 ml. OUTCOMES: After 40 months of postoperative follow-up, no recurrence or appearance of other tumors were noted. LESSONS: We recommend surgical removal of lesions in the genital area during adolescence or before adulthood. Adolescence may be the best period for surgical intervention owing to a greater risk of malignant change in adulthood. On the other hand, surgical risk should be avoided in children considering the low incidence of malignant transformation.