Table 1.
Methods for removal of congenital melanocytic nevi.
| Method | Advantages * | Disadvantages/Risks |
|---|---|---|
| Extensive data exist for the following: | ||
| None (Observation) | Up to 65% of CMN may spontaneously lighten [19], no risk of treatment complications | Psychosocial distress; for some, CMN that thicken over time, delaying treatment possibly complicating removal and impact cosmesis [20] |
| Surgical Excision | May require only one procedure if CMN is small to medium, improved cosmesis for small and medium CMN | Invasive; scarring/disfigurement (more significant in larger CMN and those in high-growth distribution); functional impairment from scarring/contracture formation; larger CMN may require multiple procedures for serial excisions, expanders, or grafts; infection; recurrence or appearance of new satellite lesions still possible; need for general anesthesia [19,21,22,23,24] |
| Limited data exist for the following: † | ||
| Laser Therapy | Noninvasive | Preferred laser combinations, settings, and frequency of treatments are not well-studied; lightens pigment rather than completely removing CMN; photosensitivity; scarring and dyspigmentation is worse in darker phototypes [25,26] |
| Curettage | Minimal equipment, noninvasive | Must be performed within a few weeks of life, may be supplemented with post-procedure skin grafting [27,28] |
| Dermabrasion | Minimal equipment, noninvasive | Must be performed within a few weeks of life; may be supplemented with post-procedure skin grafting; frequent repigmentation [18,28,29,30] |
| Chemical Peels | Minimal equipment, noninvasive | Cardiac toxicity from systemic absorption of phenol peels; comedone/milia development; photosensitivity; acetic peels generally less effective than phenol peels [31,32,33] |
| Cryotherapy | Minimal equipment, noninvasive, possible anesthetic effect causing less pain compared to other modalities [34] | Local nerve damage; hypopigmentation is common; scarring and dyspigmentation is worse in darker phototypes [35,36] |
| Electrosurgery | Minimal equipment, noninvasive | Electric shocks and burns; malfunction of implanted cardiac devices [34] |
Abbreviations: CMN, congenital melanocytic nevi. * Treatment of congenital melanocytic nevi (CMN) theoretically reduces lifetime risk of malignant melanoma (MM) by removing/destroying cutaneous nevus cells. However, there are reports of MM even after surgical excision of CMNs. One-third of MMs in patients with CMN may also involve the central nervous system secondary to neurocutaneous melanocytosis. Scarring from removal may mask developing MM, further complicating detection. † These destructive techniques all increase the risk of scarring, dyspigmentation, infection, and alopecia [33,35,37,38]. They are associated with recurrence/persistence of nevi and involve multiple treatments in larger nevi [6,39]. All may require the use of general anesthesia or sedation based upon patient age, pain tolerance, and lesion size/site. These techniques are generally not preferred in smaller to medium CMN in which surgical excision likely offers better cosmesis.