Long-term outcomes of surgical management in the patients with facial congenital melanocytic nevi.

BACKGROUND: The challenges of management of facial congenital melanocytic nevi (CMN) are the balance of the risk of malignant transformation, surgical management and the long-term evaluation of the functional and cosmetic outcomes.

OBJECTIVE: To present information on the long-term surgical management outcomes of patients with facial CMN, which may be applicable for future clinical and surgical approaches for these lesions.

MATERIAL AND METHOD: A follow-up study was performed of patients with facial CMN that were clinically evaluated by the author at Srinagarind Hospital, Khon Kaen University, between 1993 and 2011. The clinical records, photographs, surgical managements and outcomes were analyzed.

RESULTS: Among the 20 patients assessed, the female-to-male ratio was 2.33 to 1 with one patient being a twin. Most (95%) had a single and ten a large CMN. The surgical treatments of these lesions included: serial excision, excision with full thickness skin grafts, excision with composite graft, excision with local and regional flaps, and excision with tissue expanders and flap. The long-term outcome revealed that no patient's condition changed or developed into melanoma. Most of the patients had an acceptable cosmetic and functional outcome. One patient had a hypertrophic scar on the face, one a mild ectropion of the lower eyelid and 2 hyperpigmentation of the skin-grafted area.

CONCLUSION: The author presents a number of surgical techniques that may be used for decision-making in surgical management of each CMN. For the most part, analysis of the characteristics of the CMN, comprehensive evaluation of the anatomic composition of the defects and application of good reconstructive methods will provide acceptable long-term surgical outcomes and reduce the psychological impact to parents and patients. Early surgical removal of large CMNs is recommended and long-term follow-up until adulthood are the two essentials.