Treatment of Facial Nevi with Ideal Design and Splitting Technique

Background: The treatment of nevi includes surgical treatment and non-surgical treatment. Non-surgical treatment has many defects in the clinic, whereas surgical treatment is applicable to any type of nevi. However, there is no unified standard for surgical methods. Methods: Patients with facial nevi ( width ≤4 cm) and high requirements for beauty were included. Preoperatively, incision design and resection range based on the recommended wrinkles or folds of each region and principle of plastic surgery. Intraoperatively, a nevus flap was formed, and then equally divided by splitting technique. After the splitting nevus flap was resected, suture without tension was performed. Results: 21 patients underwent surgical excision. 14 patients underwent complete excision, while 7 patients underwent serial excision. The patients were satisfied with the appearance, local sensations were normal, and there were no secondary deformities of the surrounding facial organs without recurrence.Conclusion: This method is of added value, which achieved by the correct assessment of the size and location of facial nevi and designed according to the reference marks in each region and complete or serial excision.

Serial Excision for the Treatment of Giant Congenital Melanocytic Nevus: The Vietnamese Way

AIM: To investigate the efficacy of plastic surgery in the treatment of giant congenital melanocytic nevus (GCMN). METHODS: We enrolled 20 patients with 44 lesions and performed one of the following procedures: serial excision, skin grafting, tissue expansion, primary skin closure, distant flap, and adjacent flap. We assessed the outcome at 10 days and 6 months after surgery. RESULTS: Of 44 surgical sites, the most commonly used reconstruction surgeries were serial excision (16), skin grafting (16), and tissue expansion (6). Other types were rarely used. All patients with serial excision had good outcome. A total of 81% and 19% of the patients with skin grafting had good and fair outcome, respectively. Around 83% and 17% of the patients with tissue expansion had good and fair outcome. No cases had bad outcome. CONCLUSION: In conclusion plastic surgery is effective in the treatment of GCMN. There are different techniques but serial excision, skin grafts, and tissue expansion are most commonly used.

Very Rare Amelanotic Lentigo Maligna Melanoma with Skull Roof Invasion

BACKGROUND: Lentigo malignant melanoma is a melanoma subtype of chronic sun-damaged skin in elderly Caucasians. Amelanotic variants of lentigo malignant are extremely rare.CASE PRESENTATION: This is a case report of an 80-year-old male patient who presented with a non-pigmented exophytic tumour of his bald head. After complete surgical excision under the suspicion of squamous cell carcinoma, three-dimensional histologic examination confirmed an amelanotic lentigo malignant melanoma with a tumour thickness of 1.76 mm, resected R0. Five years later he developed the first relapse, the other year a satellite metastasis was surgically removed. One year later, this patient had developed a large relapsing lentigo malignant melanoma with skull roof invasion. There was no evidence of distant metastatic spread. Amelanotic lentigo malignant melanoma is a very rare tumour.CONCLUSIONS: Serial excision or slow Mohs and Mohs micrographic surgery are the treatments of choice especially in the head and neck area. These tumours may be locally very aggressive as it is shown by skull invasion in the present case.