Care of Congenital Melanocytic Nevi in Newborns and Infants: Review and Management Recommendations

PEDIATRICS ◽  
2021 ◽  
Author(s):  
Marla N. Jahnke ◽  
Judith O’Haver ◽  
Deepti Gupta ◽  
Elena B. Hawryluk ◽  
Nika Finelt ◽  
...  

A pediatric dermatology expert working group performed a narrative review to describe care related to congenital melanocytic nevi (CMN) in neonates and infants. There are no published guidelines for most aspects of care, including routine skin care and visit intervals. Few guidelines exist for surgical management; newer recommendations favor conservative practice. Emerging evidence contributes to recommendations for screening MRI to evaluate for neural melanosis and related central nervous system complications, however, more research is needed. Risk for melanoma is generally low, but those with large, giant, or multiple CMN have a higher risk. Multidisciplinary care, with a focus on family and patient preferences, is of paramount importance. Without standardized screening and management guidelines, questions abound regarding appropriate physical examination intervals, potential treatment including full or partial excision, timing and frequency of imaging, melanoma risk, and assessment for neural melanosis. This review highlights the current state of knowledge concerning care of patients with CMN, reveals gaps in the literature surrounding skin care, and provides management recommendations. We additionally discuss cutaneous complications of CMN, such as pruritus, hypertrichosis, and wound healing. Resources and references for families and providers can help patients navigate this sometimes challenging diagnosis. Finally, we contribute expert care recommendations to the current body of literature as a foundation for the development of future, more comprehensive care guidelines.

2018 ◽  
Vol 58 (3) ◽  
pp. 313-319 ◽  
Author(s):  
Andrew M. Margileth

Background. Prior reports on large congenital melanocytic nevi (LCMN) do not provide a clear management approach to physicians to advise parents or patients. Whether the presence of a halo around the nevus can guide management has not been fully explored. Design. Children born with an LCMN were observed without active intervention. Objectives. (1) To guide physicians, health providers, and parents in the management of CMN. (2) To ascertain the value of the absence or presence of a halo component of the nevi. (3) To reaffirm the diagnostic value of dermoscopy for evaluation of CMN. Materials and Methods. This was a clinical study of 45 children referred to our pediatric dermatology clinics from 1971 to- 2018. Results and Outcome. Of 45 children, 9 were lost to follow-up and 36 were followed for 6 months to 47 years. In follow-up of 17 children with a scalp CMN, spontaneous regression occurred in 6 patients. In follow-up of 5 children with a trunk LCMN, spontaneous regression occurred in 1 patient and excisional surgery was done in 4 patients. Quality of life was excellent in 35 children, but poor in 1 patient during multiple injections and excisions. Conclusions. A conservative approach to management of children with CMN, large and small, is safe, cost-effective, and results in excellent quality of life and cosmetic outcomes. Dermoscopy, a simple in-office procedure, can reassure the examiner that the congenital nevus is benign. A halo rim was present in 12 (80%) of 15 scalp CMN. The presence of a halo rim appears predictive of future regression of a CMN in the scalp or trunk.


1981 ◽  
Vol 117 (7) ◽  
pp. 379-380 ◽  
Author(s):  
M. B. Kirschenbaum

PEDIATRICS ◽  
2000 ◽  
Vol 106 (4) ◽  
pp. 736-741 ◽  
Author(s):  
F. V. Bittencourt ◽  
A. A. Marghoob ◽  
A. W. Kopf ◽  
K. L. Koenig ◽  
R. S. Bart

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